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A obesidade e o tecido adiposo na patogênese e gravidade da Leishmaniose cutânea

2026-03-05T13:53:26Z

Título: A obesidade e o tecido adiposo na patogênese e gravidade da Leishmaniose cutânea Autor(es): Nassri, Kelly Morais Lima Primeiro Orientador: Carvalho Filho, Edgar Marcelino de Abstract: Obesity is associated with worse clinical outcomes in cutaneous leishmaniasis (CL). Here, we evaluated the influence of obesity on the systemic, dermal, and adipose tissue immune responses in CL. A total of 39 obese and 43 individuals with normal BMI with ulcerated CL caused by Leishmania braziliensis confirmed by PCR were enrolled, along with 8 healthy subjects (HS), 4 with normal BMI and 4 obese. Peripheral blood mononuclear cells (PBMC) were cultured for 72 hours in the presence or absence of soluble Leishmania antigen (SLA, 5 μg/mL). Skin and adipose tissue biopsies were analyzed histologically, and cytokines and adipokines were quantified after 72-hour incubation. All patients were treated with meglumine antimoniate. The cure rate was lower in obese patients (41%) compared to those with normal BMI (70.4%) (p < 0.05). No significant differences in proinflammatory cytokine production were observed in PBMC supernatants. However, cytokines (IL-1β, IL-17, Granzyme B) and leptin were significantly higher in skin biopsies of obese compared to normal BMI CL patients (p < 0.05), and leptin levels correlated directly with these cytokines in both groups. Adipose tissue was infiltrated by inflammatory cells, with larger inflammatory areas in obese CL patients (p < 0.05). Cytokines were largely undetectable in adipose tissue, except for elevated CCL2. Notably, leptin and adiponectin levels were markedly increased in CL patients compared to HS, suggesting infection-driven modulation of adipocyte function. These findings demonstrate that CL enhances adipokine production and that obesity amplifies local inflammatory responses, contributing to greater disease severity and therapeutic failure in obese individuals. Editora / Evento / Instituição: UNIVERSIDADE FEDERAL DA BAHIA Tipo: Dissertação

Eficácia da miltefosina associada à termoterapia, comparada à miltefosina em monoterapia ou ao uso de antimoniato de meglumina no tratamento da leishmaniose cutânea: ensaio clínico randomizado

2026-01-16T17:42:26Z

Título: Eficácia da miltefosina associada à termoterapia, comparada à miltefosina em monoterapia ou ao uso de antimoniato de meglumina no tratamento da leishmaniose cutânea: ensaio clínico randomizado Autor(es): Nolasco, Sandra Luiza Tolentino Primeiro Orientador: Machado, Paulo Roberto Lima Abstract: Introduction: Leishmaniasis, an infectious disease caused by protozoa of the genus Leishmania, affects 98 countries and ranks among the six most relevant diseases due to its deforming potential, particularly in underdeveloped regions. Meglumine antimony (MA), the standard treatment since the 1940s, faces challenges such as toxicity, therapeutic resistance, and low adherence. Alternatives like miltefosine (MF) (approved in India for visceral leishmaniasis in 1998) and thermotherapy have emerged to expand access and reduce adverse effects. Objective: To evaluate whether the combination of MF and thermotherapy is non inferior to MF monotherapy or MA in treating cutaneous leishmaniasis, analyzing cure rates (D90 and D180), healing time, safety, and relapses. Methods: An open-label randomized clinical trial with 27 patients (12–60 years) diagnosed with cutaneous leishmaniasis via detection of L. braziliensis DNA or amastigote forms in histopathology, treated at the Corte de Pedra Reference Center, Bahia. Groups were: G1 (MA): 20 mg/kg/day, 20 days); G2 (MF): 2.5 mg/kg/day, 28 days); G3 (MF): 2.5 mg/kg/day, 21 days + 1 Thermomed® thermotherapy session at 50°C). Results: Treatment failure rates in G1, G2, and G3 were 43%, 30%, and 20%, respectively. Cure rates at day 90 (D90) were 43% (G1), 70% (G2), and 80% (G3), while at day 180 (D180) they reached 57% (G1), 90% (G2), and 80% (G3). Mean healing time was 97 days for G1, 90 days for G2, and 76 days for G3, with a statistically significant difference between G3 and G1 (p = 0.04). Side effects in miltefosine groups included vomiting (70% in G2 and 60% in G3), nausea (40% in G2 and 30% in G3), and diarrhea (20% in both). In G1, 57.1% reported arthralgia and 71.1% myalgia. Secondary infections occurred in 14.2% of G1 and 20% of G3. Conclusions:The combination of MF and thermotherapy demonstrated non inferior effectiveness compared to MF monotherapy and MA in treating cutaneous leishmaniasis. G3 showed higher cure rates and significantly shorter healing time. Editora / Evento / Instituição: Universidade Federal da Bahia Tipo: Dissertação

Desempenho cognitivo na Esclerose Múltipla e no Espectro da Neuromielite Óptica: estudo transversal em um centro de referência em neuroimunologia no Brasil

2026-01-14T16:43:23Z

Título: Desempenho cognitivo na Esclerose Múltipla e no Espectro da Neuromielite Óptica: estudo transversal em um centro de referência em neuroimunologia no Brasil Autor(es): Nascimento, Thiago Santos Primeiro Orientador: Oliveira Filho, Jamary Abstract: Background: Multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) are inflammatory demyelinating diseases of the central nervous system. Cognitive impairment is well established in MS but less defined in NMOSD. Objectives: Compare cognitive performance between NMOSD and MS patients in a Brazilian cohort and explore clinical correlates. Methods: This cross-sectional study included 64 patients (32 NMOSD, 32 MS). Diagnoses followed the 2015 NMOSD consensus and 2017 McDonald criteria. Epidemiological variables were analyzed, including the Expanded Disability Status Scale (EDSS). Cognition was assessed with the Brief Repeatable Battery of Neuropsychological Tests (Selective Reminding Test, Spatial Recall Test, Symbol Digit Modalities Test, Paced Auditory Serial Addition Test, Word Generation List) and the Hayling Sentence Completion Test. Motor function was evaluated with the Nine-Hole Peg Test (9-HPT) and Timed 25-Foot Walk. Mood was screened with the Hospital Anxiety and Depression Scale. Raw scores were converted into z-scores from Brazilian norms. Group comparisons used Mann–Whitney and chi-square tests, with generalized linear models adjusted (age, education, and EDSS). Cognitive impairment was defined as global z-score < –1.5. Results: Cognitive impairment occurred in 69% of NMOSD and 78% of MS patients (p=0.42). MS patients performed worse in executive control (Hayling, p=0.029), whereas NMOSD patients were slower on psychomotor tasks (9-HPT, p=0.017). EDSS correlated with executive and psychomotor deficits in NMOSD, and with psychomotor speed in MS. Conclusion: Cognitive impairment is frequent in both disorders, with overlapping but distinct patterns. These findings challenge the notion of NMOSD as cognition-sparing and support systematic cognitive screening and rehabilitation. Editora / Evento / Instituição: UNIVERSIDADE FEDERAL DA BAHIA Tipo: Dissertação

Efeitos da terapia hormonal de afirmação de gênero na conectividade cerebral

2025-09-19T17:57:56Z

Título: Efeitos da terapia hormonal de afirmação de gênero na conectividade cerebral Autor(es): Pedreira, Clarissa de Castro Carvalho Primeiro Orientador: Oliveira, Luciana Mattos Barros Abstract: Background: There has been an increase in the number of transgender and gender diverse (TGD) people seeking gender-affirming hormone therapy (GAHT). Few studies have examined the effects of GAHT on brain connectivity. The hormonal effects on the brain may be through its influence on intrinsic connectivity. Objectives: To characterize the effects of GAHT on patterns of brain’s intrinsic connectivity of the default mode network (DMN) and salience network (SN) in TGD individuals. Methods: A prospective study of TGD individuals, assigned male at birth (AMAB) and assigned female at birth (AFAB), before and after GAHT was conducted. Participants were scanned using functional magnetic imaging at rest baseline and 6 months after GAHT. restingstate Functional Connectivity (rs-FC) maps were generated for each participant. Regions of interest were generated for key nodes anchoring DMN and SN, specifically the posterior cingulate cortex (PCC) and the dorsal anterior insula (dAI). Baseline and 6-month rs-FC maps were then compared, generating a single group level map of significant differences between timepoints for each seed, PCC and dAI, at p < 0.05, uncorrected. Results: 14 TGD individuals (AMAB n = 7, AFAB n = 7), mean age 27.68 (23.44 – 30.52) were enrolled. In the AMAB group, there was an increase in rs-FC from the PCC seed to the precuneus (within DMN) and a decrease in rs-FC from the dAI seed to the mid cingulate cortex and orbitofrontal cortex (within SN) after estradiol and antiandrogen use 93 (p_uncorr < 0.05). In the AFAB group, there was a significant decrease in rs-FC from the PCC seed to the precuneus, superior frontal gyrus, parahippocampal gyrus, and insula (within the DMN and between the DMN and SN) after testosterone use (p_uncorr < 0.05). Additionally, rs-FC from the dAI seed to the amygdala, insula, and anterior cingulate cortex (within the SN) significantly decreased after GAHT with testosterone (p_uncorr < 0.05). Conclusions: Our findings suggest that GAHT can influence patterns of intrinsic connectivity within brain networks involved in emotional and cognitive process in TGD individuals. This study highlights the brain's remarkable capacity to adapt in response to GAHT. Editora / Evento / Instituição: Programa de Pós-Graduação em Ciências da Saúde Tipo: Tese