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Dissertations/Thesis

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2025

	Dissertations
1	ANA CAROLINA ZIMMERMANN SIMÕES INTERVENTIONS FOR THE TREATMENT OF USUAL-TYPE VULVAR INTRAEPITHELIAL NEOPLASIA: A SYSTEMATIC REVIEW AND META-ANALYSIS Advisor : ANA KATHERINE DA SILVEIRA GONCALVES DE OLIVEIRA COMMITTEE MEMBERS : ANA KATHERINE DA SILVEIRA GONCALVES DE OLIVEIRA JANAINA CRISTIANA DE OLIVEIRA CRISPIM FREITAS KLEYTON SANTOS DE MEDEIROS Data: Feb 7, 2025 Show Abstract Introduction: Usual-type vulvar intraepithelial neoplasia, associated with HPV, accounts for approximately 20% of vulvar squamous cell carcinoma cases. In 2020 alone, 45,240 new cases of vulvar carcinoma were diagnosed, leading to 17,427 deaths, according to a study on the global incidence and mortality of 36 cancer types. The treatment aims to eradicate the affected tissue while preserving its appearance and functionality as much as possible. Traditional and well-established treatments primarily involve surgical techniques, which, despite enabling histological tissue analysis, may exacerbate symptoms due to anatomical alterations, scarring, and sensory changes. These outcomes can negatively impact quality of life and female sexual function. In this context, less invasive approaches such as ablative procedures and topical agents have been investigated to expand treatment alternatives, particularly for extensive and multifocal lesions. However, these approaches may not always be equally effective or well-tolerated due to adverse effects. Objectives: This study primarily aimed to assess the efficacy of various treatments and, secondarily, their adverse effects and tolerability to evaluate adherence rates. Methods: The systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The protocol was pre-registered in the PROSPERO International Prospective Register of Systematic Reviews (registration number: CRD42023442818). A comprehensive search was conducted across PubMed, Scopus, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials databases without restrictions on publication date or language. The search was performed on February 5, 2024. Randomized clinical trials comparing any treatment for high-grade vulvar intraepithelial lesions to placebo or other treatments were included. Data were extracted independently by two authors. Risk of bias was assessed using the Cochrane Risk of Bias tool (RoB 2.0). Data synthesis was conducted using RevMan 5.4. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach was used to evaluate the strength of evidence. Results: The search yielded 10,306 studies, and eight met the inclusion criteria for this review. According to the meta-analysis, which included two studies comparing 5% imiquimod to placebo, total lesion resolution was observed in 55.3% of women in the intervention group and in none of the placebo group (RR 18.21, 95% CI 2.60–127.69), with moderate-quality evidence. Compared to 1% cidofovir, 5% imiquimod demonstrated similar tolerability and adverse effect profiles, with vulvar pain, pruritus, fatigue, and headache being the most common. The complete response rate was 57% (90% CI 47–67) for cidofovir and 61% (90% CI 50–71) for imiquimod. When compared to ablative and excisional surgical treatments, 5% imiquimod was well-tolerated and showed a strong trend toward non-inferiority. Ultrasonic surgical aspiration resulted in less scarring compared to CO2 laser vaporization, with similar efficacy between the techniques. The 10% sinecatechins ointment (Veregen®) was well-tolerated and did not produce significant adverse effects. Compared to placebo, sinecatechins demonstrated clinical efficacy in lesion resolution (p = 0.002). The natural compound indole-3-carbinol (I3C) and omiganan, while well-tolerated and achieving good adherence to protocols, did not prove effective in lesion resolution.
2	HÉGILA DA SILVA DANTAS Effectiveness of Non-Pharmacological Therapies for Chronic Pelvic Pain in Endometriosis Advisor : MARIA THEREZA ALBUQUERQUE BARBOSA CABRAL MICUSSI COMMITTEE MEMBERS : AYANE CRISTINE ALVES SARMENTO GRASIELA NASCIMENTO CORREIA MARIA THEREZA ALBUQUERQUE BARBOSA CABRAL MICUSSI Data: Feb 10, 2025 Ata de defesa assinada: Show Abstract Endometriosis is a complex condition characterized by significant symptoms and complications, such as chronic pelvic pain and infertility. Current therapeutic options, including medications and surgical procedures, often do not provide complete relief and may be associated with unwanted side effects. Objectives: 1) To evaluate the effectiveness of non-pharmacological methods in relieving chronic pelvic pain compared to placebo therapies in women with endometriosis. 2) To assess the effectiveness of transcranial direct current stimulation (tDCS) for pain relief in women with endometriosis. Methods: 1) A systematic review with meta-analysis was conducted. Searches were performed in the databases Web of Science, PubMed, Scielo, Embase, and Pedro. Randomized controlled trials using non-pharmacological therapies and assessing chronic pelvic pain as a primary outcome were included. The risk of bias was evaluated using the Cochrane Risk of Bias 2 (RoB 2) tool. 2) Ten sessions of tDCS were applied to 10 women, with 10 active and 10 sham treatments in the M1 area. Visual analog scale for pain and functional tests were applied before and after the intervention. Descriptive statistics and 2x2 ANOVA were used. Results: Nine studies were included, comprising 432 women aged 13 to 50 years. The analyzed interventions included acupuncture, yoga, integrative psychotherapy, aerobic training, cardiorespiratory training, telerehabilitation, and virtual reality. All studies reported a reduction in pain after the interventions compared to baseline. The intervention group demonstrated greater effectiveness in pain reduction compared to the control group, except in one study. Five studies showed a high risk of bias, while four showed a low risk. Secondary outcome analysis and meta-analysis will be conducted during the defense phase. In the clinical trial, there were no differences in sociodemographic data between groups. No differences were observed in pain levels or functional assessments before and after the intervention. Conclusions: The systematic review and meta- analysis will aid in understanding the most effective non-pharmacological therapies for pain relief in women with endometriosis, supporting the development of new research and public policies to ensure access to evidence-based therapies. The clinical trial remains preliminary and requires a larger sample size for more conclusive results.
3	PAULA LIMA GALVÃO GOMES SERPA Association of SARS-CoV-2 infection with retinol status in pregnant women: A case-control study Advisor : KARLA DANIELLY DA SILVA RIBEIRO RODRIGUES COMMITTEE MEMBERS : JULIANA FERNANDES DOS SANTOS DAMETTO KARLA DANIELLY DA SILVA RIBEIRO RODRIGUES MAYARA SANTA ROSA LIMA Data: Feb 25, 2025 Show Abstract There is evidence that situations of infection and inflammation are related to vitamin A deficiency (VAD), especially in children and pregnant women. Therefore, the objective of this research was to evaluate the influence of SARS-CoV-2 (COVID-19) infection on the vitamin A (retinol) status of pregnant women treated at a referral hospital for high-risk pregnancies. This is a case-control study comprising 60 pregnant women hospitalized with symptoms of COVID-19 between February 2021 and February 2022, and grouped according to the diagnosis of infection (with COVID-19, n=29 and symptomatic without COVID -19, n= 31). For comparative purposes, 63 low-risk pregnant women analyzed in a period prior to the emergence of COVID-19 in the same maternity hospital were included. The diagnosis of COVID-19 was made using RT-PCR for SARS-CoV-2 in a combined nasopharyngeal swab. Data collection comprised socioeconomic, demographic, clinical, biochemical information and retinol analysis in the women's serum. Retinol was analyzed by Ultra Performance Liquid Chromatography and VAD was determined when serum retinol <20 μg/dL. For statistical analysis, JASP and IBM SPSS software were used. The average age of pregnant women was 26 years old, practically half of them lived in Natal-RN (51.2%), and only two pregnant women had VAD (1.80%). The mean serum retinol was higher in pregnant women diagnosed with COVID-19 (54.50 μg/dL) than in the other groups (p<0.001). Linear regression analysis adjusted for gestational age at birth confirmed the positive association between retinol levels and the presence of COVID-19 (β= 17.22, 95%CI= 9.670 - 24.77, p<0.001). The data demonstrated that the presence of SARS-CoV-2 infection appears to maintain circulating serum retinol levels, which differs from data in the literature in situations of infection with other viruses and at other stages of life. Given this result and the limitations of the literature on retinol metabolism in pregnant women, it is noteworthy that this is the first study that verified the influence of COVID-19 on retinol in pregnant women, and it is therefore necessary to verify the behavior of retinol in this population during COVID-19, and whether serum retinol is the most appropriate biomarker in this situation. This study was approved by the Research Ethics Committee of the Hospital Universitário Onofre Lopes.
4	SARAH DANTAS VIANA MEDEIROS Neonatal Outcomes of Pregnant Women with Pre-Eclampsia Advisor : MARCELA ABBOTT GALVAO URURAHY COMMITTEE MEMBERS : AYANE CRISTINE ALVES SARMENTO KARLA SIMONE COSTA DE SOUZA MARCELA ABBOTT GALVAO URURAHY Data: Feb 25, 2025 Show Abstract Introduction: Preeclampsia (PE) is a pregnancy-specific disease that develops from the 20th week of gestation characterized by increased blood pressure (≥ 140 x 90 mmHg) accompanied by proteinuria and/or target organ dysfunction. PE is associated with both maternal and neonatal morbidity and mortality, being the main cause of elective prematurity in Brazil. Neonatal outcomes commonly related to PE are prematurity, low birth weight, respiratory distress syndrome (RDS), sepsis, bronchopulmonary dysplasia, and intraventricular hemorrhage. Objective: To evaluate neonatal outcomes, clinical, ultrasound, biochemical and hematological parameters of pregnant women with early and late PE. Method: This is a longitudinal, observational and prospective study in which 32 pregnant women diagnosed with PE, as well as their respective neonates, were allocated in two groups: early PE (n=21) and late PE (n=11). For the evaluation of biochemical and hematological parameters, fasting blood samples were collected from pregnant women. Maternal and neonatal data were also obtained from electronic medical records. Results: The early PE group had the lowest number of prenatal consultations (p = 0.032), higher values of maternal diastolic blood pressure at admission (p = 0.049) and maternal urea (p = 0.029), as well as lower gestational age (p = 0.004) and birth weight (p = 0.021), higher rate of admission to the neonatal intensive care unit (p < 0.001), sepsis (p = 0.014), SDR (p = 0.003) and need for ventilatory support (p = 0.027). Conclusion: Early pre-eclampsia has an important impact on neonatal outcomes.
5	TALLES HENRIQUE DE ARAUJO PONTES Evaluation of Cytokines in the Th1, Th2, and Th17 Profile in Patients with High-Grade Intraepithelial Lesions and Cervical Cancer Advisor : JANAINA CRISTIANA DE OLIVEIRA CRISPIM FREITAS COMMITTEE MEMBERS : DANIELLA REGINA ARANTES MARTINS SALHA DEYSE DE SOUZA DANTAS JANAINA CRISTIANA DE OLIVEIRA CRISPIM FREITAS MARQUIONY MARQUES DOS SANTOS Data: Feb 26, 2025 Show Abstract The imbalance of cellular expressions mediating the immune response resulting from HPV infections in high-grade lesions and cervical carcinoma, such as the profile of Th1, Th2, and Th17 cells from peripheral blood, has been extensively studied in recent research. From this, the need for a better understanding of the immune response through the in situ cytokine profile of HPV-mediated lesions has emerged. We quantified cytokines of the Th1, Th2, and Th17 profiles in cervical-vaginal scraping (CVS) samples using flow cytometry, correlating them with clinical and immunological findings. Through a cross-sectional study, CVS samples were collected at the Lower Genital Tract Pathology (LGTP) outpatient clinic from patients with High-Grade Intraepithelial Lesion (CIN 3) and Cervical Cancer (CC), while patients with no intraepithelial lesion were included as the control group. We assessed the levels of Th1, Th2, and Th17 cytokines in the CVS and compared the levels between the study groups and the control group. Higher cytokine levels (TNF- α, IFN-γ, IL-10, and IL-2) were observed in patients with CC compared to those with CIN 3 and the control group. Therefore, the persistence of lesions and the development of CC may lead to an immunological imbalance that worsens the progression of the disease.
6	KAYONARIA KARDENIA ALVES DA COSTA GOMES HPV E6/E7 mRNA for cervical cancer screening with self- collected samples: a protocol for a systematic review. Advisor : JANAINA CRISTIANA DE OLIVEIRA CRISPIM FREITAS COMMITTEE MEMBERS : ANA KATHERINE DA SILVEIRA GONCALVES DE OLIVEIRA AYANE CRISTINE ALVES SARMENTO JANAINA CRISTIANA DE OLIVEIRA CRISPIM FREITAS KLEYTON SANTOS DE MEDEIROS Data: Feb 27, 2025 Show Abstract Cancer is associated with high-risk HPV. E6/E7 oncoproteins are highly expressed in high-risk HPV. Self-collection is a screening method that allows women to collect their own samples for HPV detection, and has been considered a promising alternative to screening for cervical cancer. This study aimed to evaluate the association between HPV E6/E7 mRNA and cervical cancer in self-collected samples. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was performed in the PubMed, Embase, Scopus, Web of Science and LILACS databases, with no restrictions on language or publication period. Cross-sectional studies involving the detection of HPV E6/E7 mRNA in self-collected cervical cancer samples were included. Study selection and data extraction were conducted independently by two reviewers. Risk of bias assessment was performed using the Joanna Briggs Institute (JBI) tool for cross-sectional studies. This systematic review aims to assess whether mRNA expression of E6 and E7 oncoproteins via cervical self- collection can be used in cervical cancer screening.
7	THAYANNE GURGEL DE MEDEIROS MENDES Impact of Gestational Hypertensive Syndromes on nutritional and clinical outcomes in preterm newborns: a prospective cohort Advisor : MARCIA MARILIA GOMES DANTAS LOPES COMMITTEE MEMBERS : CLAUDIA SAUNDERS JULIANA FERNANDES DOS SANTOS DAMETTO MARCIA MARILIA GOMES DANTAS LOPES NIVIA MARIA RODRIGUES ARRAIS Data: Feb 27, 2025 Show Abstract Hypertensive syndromes in pregnancy (HGS) are characterized by changes in blood pressure levels during the gestational period. For children of women with HGS, premature birth is one of the main consequences, which can impact neonatal outcomes. The objective of this research was to compare the nutritional outcomes of preterm newborns (PTNB) born to women with HGS to children of normotensive women. The study was a prospective cohort study with a quantitative approach. The study participants were PTNBs born at the Januário Cicco Maternity School, in Natal-RN, from October 2021 to November 2023 who were hospitalized in the neonatal intensive care unit (NICU). PTNBs with gestational age between ≥23 and <37 weeks and weight less than 2500g were included, and neonates diagnosed with severe congenital malformation or inborn errors of metabolism were excluded. The PTNBs were divided into 2 groups, according to exposure to HGS. Data collection was performed using electronic medical records and statistical analysis was performed using SPSS version 28.0. Of the 220 pregnant women monitored, half had GHS. There was a significant statistical association between GHS and maternal age >35 years (p=0.013) and cesarean delivery (p<0.01). Preterm infants born to women with GHS had a greater need for parenteral nutrition (p=0.017) and a higher risk of inadequate enteral nutrition (p=0.020). Furthermore, children born to women with GHS had a higher prevalence of being classified as small for gestational age at birth (p<0.001) and, upon discharge from the NICU, with extrauterine growth restriction (p=0.018), when compared to children born to normotensive women. The results confirm that GHS are associated with unfavorable nutritional outcomes in preterm infants. Children of women with GHS had difficulty maintaining adequate nutritional status, with lower Z-scores at birth and at discharge from the NICU. Therefore, children of women with GHS require early and individualized nutritional interventions to improve recovery and growth during their stay in the NICU.
8	CAZUY ALVES UCHOA GUERRA EVALUATION OF THE PELVIC FLOOR MUSCLES BEFORE AND AFTER SURGERY FOR ISOLATED URINARY INCONTINENCE AND ASSOCIATED PELVIC ORGAN PROLAPSE REPAIR Advisor : GUSTAVO MAFALDO SOARES COMMITTEE MEMBERS : GUILHERME PERTINNI DE MORAIS GOUVEIA GUSTAVO MAFALDO SOARES MARIA THEREZA ALBUQUERQUE BARBOSA CABRAL MICUSSI Data: Feb 28, 2025 Show Abstract The objective of this study is to evaluate the quality of life and pelvic floor muscle function in women undergoing surgery for isolated urinary incontinence and incontinence associated with bladder prolapse correction. A prospective cohort study was conducted with women who were indicated for pelvic organ prolapse correction surgery (POPg = 47) and those undergoing surgery for both prolapse and urinary incontinence (IU+POPg = 53). All participants were assessed before surgery (T1) and followed up at 3 months (T3), 6 months (T4), and 12 months (T5) postoperatively. The assessment included a sociodemographic data form, a functional examination of the pelvic floor muscles (vaginal manometry), and the application of the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB). An unpaired Student’s t-test was used to compare sociodemographic and clinical data, while a one-way repeated measures ANOVA was performed to assess differences in questionnaire scores and manometry across the four time points. The Bonferroni post-hoc test was applied when a statistically significant difference was identified. A significance level of 5% was adopted for all analyses. The results showed a similar improvement in urinary symptoms in both groups. However, women who underwent surgery exclusively for urinary incontinence demonstrated better pelvic floor muscle function (PFMF) over one year post-surgery. In conclusion, pelvic floor muscle function decreased after surgery, with greater impairment observed in those who underwent correction for both prolapse and urinary incontinence. Based on these findings, immediate postoperative pelvic floor muscle training is suggested.

2024

	Dissertations
1	BIANCA CAROLINE DA CUNHA GERMANO USE OF ACETYLSALICYLIC ACID, EXPRESSION OF PRE-ECLAMPSIA MARKERS AND UTERINE ARTERY DOPPLER IN THE SECOND GESTATIONAL TRIMESTER Advisor : RICARDO NEY OLIVEIRA COBUCCI COMMITTEE MEMBERS : RICARDO NEY OLIVEIRA COBUCCI MARCELA ABBOTT GALVAO URURAHY DEYLA MOURA RAMOS Data: Feb 28, 2024 Show Abstract Preeclampsia (PE) occurs in pregnancy with hypertension and proteinuria, or target organ failure, and is associated with maternal and fetal morbidity and mortality. Among the risk factors for PE is maternal obesity. In pathophysiology, vascular and placental inflammatory dysfunction occurs, altering serum and biophysical markers. Acetyl Salicylic Acid (AAS) can prevent the disease by reducing the inflammatory process. The objective of the study was to analyze, in pregnant women in the second trimester of pregnancy, whether the use of AAS interferes with the Doppler of the uterine arteries and serum PE markers, and observe how they behave in obese pregnant women. This was a cross-sectional study, involving 71 pregnant women between 20 and 24 weeks and 06 days of gestation, recruited in two municipalities in Rio Grande do Norte between December 2022 and October 2023. Questionnaires were applied to characterize the population; morphological ultrasound of the 2nd trimester with Doppler assessment of the uterine arteries and measurement of serum PlGF (Placental Growth Factor) levels. The data were tabulated in SPSS (Statistical Package for the Social Sciences – version 4.2.2) to perform descriptive analysis, Shapiro-Wilk test and Spearman correlation. The significance level was 5%. The average body mass index (BMI) of the sample was 31.02. 38 pregnant women confirmed the use of AAS and in this group the mean pulsatility index (PI) values of the uterine arteries were 1.03 and PlGF 307.80, and in those who did not use it, the values were 0.95 and 325. 3, respectively. In this study, using AAS did not contribute to reducing the PI of the uterine arteries and there was no significant difference in the mean PIGF. Larger studies are important to confirm these results.
2	GEORGIA HACKRADT REGO PREVALENCE OF SEXUAL DYSFUNCTION IN WOMEN UNDERGOING PAP SMEAR COLLECTION AND MOLECULAR DETECTION OF HPV IN UNIVERSITY HOSPITAL OF RIO GRANDE DO NORTE Advisor : RICARDO NEY OLIVEIRA COBUCCI COMMITTEE MEMBERS : ANA ANDREA BARBOSA MAUX DEYSE DE SOUZA DANTAS RICARDO NEY OLIVEIRA COBUCCI Data: Feb 29, 2024 Show Abstract Satisfactory sexual function in women is closely linked to their health and quality of life. Diagnoses such as HPV can have a negative impact on a woman’s emotional health, interfering with the expression of sexuality and causing feelings of shame or fear, exacerbating anxiety and stress. A cross-sectional study was conducted with the aim of assessing the prevalence of sexual dysfunction in adult women treated at a university hospital in Natal/RN. Sixty-eight sexually active women in stable relationships, aged between 18 and 45 years, were included in the study and recruited from the gynecology outpatient clinic for cervical cytology and molecular detection of Papillomavirus (HPV). Two validated instruments, the Female Sexual Function Index (FSFI) and the Sexual Quotient – Female Version (SQ-F), were used to identify sexual dysfunction, along with a sociodemographic data sheet collecting information on age, race, education, length of union/marriage, number of sexual partners, among others. Data analysis was performed using the SPSS software (Statistical Package for the Social Sciences, Chicago, USA) version 28. The prevalence of sexual dysfunction was 47.1% considering the scores obtained by FSFI and 25% with the scores of SQ-F. There was a significant correlation only with the education variable, indicated by a higher prevalence of sexual dysfunction among women who completed high school compared to those with incomplete or complete higher education. Therefore, in this observational study, the prevalence of sexual dysfunction was high, with almost half of the women presenting a disorder when evaluated with FSFI. Furthermore, the prevalence ratio of dysfunction was significantly higher in the group of women with education up to high school, regardless of the instrument used for identification. Thus, it is demonstrated that women seeking routine gynecological care may present sexual dysfunctions. However, they often do not receive a diagnosis, as doctors focus on prevention and control of infections or lesions, rarely investigating sexual behavior. The conduct of multicenter observational studies is necessary to establish a more accurate epidemiology and to develop strategies for including protocols for assessing sexual function in women’s health.
3	VERÔNICA LARYSSA SMITH ELECTROMYGRAPHIC ANALYSIS OF THE FUNCTION OF THE PELVIC FLOOR MUSCLES OF POST-PELVIC MOBILITY PREGNANT WOMEN Advisor : RICARDO NEY OLIVEIRA COBUCCI COMMITTEE MEMBERS : RICARDO NEY OLIVEIRA COBUCCI SILVANA ALVES PEREIRA LARISSA RAMALHO DANTAS VARELLA Data: Mar 13, 2024 Show Abstract Understanding the intricate relationship between pregnancy and the pelvic floor is crucial to managing potential problems related to pelvic floor dysfunction during and after pregnancy. Appropriate prenatal care, including exercises and interventions to support pelvic health, can help mitigate complications and promote overall well-being for pregnant women. The objective of this case series was to analyze the function of the pelvic floor muscles of pregnant women after pelvic mobility exercises using surface electromyography (EMG). The methodology was a cross-sectional, case series observational study, which evaluated seven (7) pregnant women in the third trimester. Data collection consisted of functional assessment of the pelvic floor through surface electromyography, with the following protocol: thirty seconds of rest to record basal activity, three maximal voluntary contractions maintained for two seconds, with a one-minute interval between each one. and three sustained contractions, maintained for six seconds, with a one-minute interval between each one. After the evaluation, pelvic exercises of lateral hip tilt, pelvic antero- and retroversion and circumduction were performed and, subsequently, all were reevaluated by EMG following the same evaluation protocol. The collected data were analyzed using SPSS software, version 13.0. The results indicated a significant improvement in maximum voluntary contraction, in the adjusted mean variable (p 0.040). In the other parameters evaluated, although there was no significant statistical difference, the values found may indicate an improvement in the functionality of the pelvic floor muscles after pelvic movement exercise. The pelvic exercise applied in this series of cases caused changes in all variables evaluated in the studied group, considering the myoelectric response and the functionality of the pelvic floor muscles in pregnant women in the third trimester. Studies with a larger sample and higher level of evidence are needed to confirm these results.
4	ARLEN CABRAL BARRETO Evaluation of th1, th2 and th17 response and hla-g checkpoint molecule in women with infertility Advisor : JANAINA CRISTIANA DE OLIVEIRA CRISPIM FREITAS COMMITTEE MEMBERS : JANAINA CRISTIANA DE OLIVEIRA CRISPIM FREITAS JOSE MARIA SOARES JUNIOR MARCELA ABBOTT GALVAO URURAHY Data: Oct 23, 2024 Show Abstract The search for biomarkers with predictive and prognostic value in the pathophysiology of infertility among couples is one of the objectives in the field of reproductive immunology. It is known that immunoregulatory molecules and the expression of pro and anti-inflammatory mediators contribute to reproductive medicine. However, the role of these molecules in infertility is not yet fully understood. In this context, this study aims to evaluate the expression of the HLA-G checkpoint molecule and the levels of cytokines of the Th1, Th2, and Th17 profiles in serum and Follicular Fluid (FF) in infertile women undergoing In Vitro Fertilization (IVF). This study included 75 women who signed the Informed Consent Form (ICF) and were subsequently stratified into two groups. The IVF group (n=39) consisted of women undergoing IVF recruited at the Center for Assisted Reproduction (CAR) of a teaching hospital. The control group (n=36) consisted of women who had at least one pregnancy with a live birth. The HLA-G molecule was quantified in the peripheral blood of all study participants using PE-conjugated anti-HLA-G antibody, and cytokine quantification was performed in the serum and FF of participants using the Cytokine Bead Assay kit. Flow cytometry was used as the quantification technique in both tests. As a result, there was lower expression of HLA-G in lymphocytes (p=0.0001) and granulocytes (p= 0.0191) in the IVF group compared to the control group. In addition, HLA-G+ lymphocytes correlated with fertilization rate (p=0.0359). Regarding cytokines, there was a higher amount of IL-2 (p=0.0012), IL-17 (p=0.0021), IL-6 (p=0.0009), IL-10 (p=0.0004), and IL-4 (p=0.0019) in the serum of IVF group patients compared to the control group, as well as a higher amount of IL-17 (p=0.0001), IL-6 (p=<0.0001), IL-10 (p=<0.0001) in the FF compared to serum in the group of infertile women. These results indicate an important role of these molecules in immunomodulation in the context of infertility. This is the first study to associate the Th1, Th2, and Th17 response profiles and the HLA-G molecule in different infertility conditions in the IVF scenario.
5	MARIA CAROLINA DANTAS CAMPELO NEVES PROFILE OF CELL DEATH IN WOMEN WITH DIABETES TYPE 1, 2 AND GESTATIONAL DIABETES Advisor : DANIELLA REGINA ARANTES MARTINS SALHA COMMITTEE MEMBERS : DANIELLA REGINA ARANTES MARTINS SALHA CAROLINE EVELIN NASCIMENTO KLUCZYNIK MARIA OLIVIA AMADO RAMOS BACELLAR Data: Oct 25, 2024 Show Abstract Introduction: The gestational period is marked by physiological changes that seek to meet the demands of mother-baby interaction for the balanced development of the baby. A pregnancy accompanied by Diabetes Mellitus enhances oxidative stress mediated by the inflammatory response that culminates in the production of reactive oxygen and nitrogen species, generating a maternal and placental imbalance characterized by damaging molecules such as DNA and RNA. Therefore, the impact caused by Diabetes Mellitus on cells and its outcomes have been investigated in pregnant women. Objective: To analyze the cellular profile and characteristics together with the inflammatory process of Diabetes Mellitus during pregnancy in a teaching maternity hospital. Methodology: This is an observational and descriptive study, with a quantitative approach, operationalized in two stages: cross-sectional study and case-control study. 240 diabetic and 12 non-diabetic pregnant women were characterized sociodemographically. Of the 240 diabetic pregnant women, 23 were analyzed for the degree of apoptosis in the lymphocyte, monocyte and granulocyte populations of whole blood, incubated with the fluorochromes annexin V FIT-C and/or propidium iodide and characterized by Cytoflex flow cytometry (Beckman Coulter) for detection of apoptosis. Results: Of the population studied, 46.25% were between 30 and 39 years old, 57.08% were brown, 50% had a salary income ≤ 01 minimum wage, 57.08% had high school education, 62.92% lived in rural areas; 65.83% had sanitation, 97.92% had electricity and 71.25% lived on paved streets. 67.74% did not notice symptoms of diabetes before diagnosis, 77.41% were diagnosed during pregnancy, 57.14% had a family history of diabetes and 67.86% had a family history of hypertension. Of the 240 pregnant women, 79.17% had GDM, 5.83% had DM1 and 15.00% had DM2. In addition, 40.42% had hypertension and 19.58% reported having other associated comorbidities. The characterization of the cellular profile in the study population showed a greater quantity of live cells in the distribution of lymphocytes and granulocytes between the control population and women with GDM (p=0.001/p=0.04) and with DM1/DM2 (p=0.04). Also in the lymphocyte population, early apoptosis showed a greater statistical difference than late apoptosis. Necrosis showed a statistically significant difference between the control group and the group of women with GDM (p=0.03). Monocytes did not show a statistically significant difference between the groups regarding live cells in early and late apoptosis. The diabetic participants whose blood was analyzed were between the 12th and 38th gestational week and apoptosis was present in all of them. Final considerations: In general, there was a greater quantity of live cells in the control population when compared to the groups of pregnant women with diabetes in the lymphocyte and granulocyte population. In addition, the difference in the expression of apoptosis between the groups of women with GDM only and the group of women with type 1 and 2 diabetes was minimal. Therefore, regardless of the type of diabetes, the pregnant woman suffered cell loss throughout the pregnancy.
6	MARIA ELIONÊS DE OLIVEIRA ARAUJO Impact of ultra-processed food consumption on maternal-child weight outcomes among women with Gestational Diabetes Mellitus: A cohort study. Advisor : KARLA DANIELLY DA SILVA RIBEIRO RODRIGUES COMMITTEE MEMBERS : KARLA DANIELLY DA SILVA RIBEIRO RODRIGUES JULIANA FERNANDES DOS SANTOS DAMETTO CLAUDIA SAUNDERS Data: Oct 30, 2024 Show Abstract Although the literature presents the negative health consequences of consuming ultra-processed foods (UPF) in relation to adiposity and the development of chronic non-communicable diseases, there is still a scarcity of studies evaluating the impact of this consumption during the gestational period, especially on obstetric and perinatal outcomes in women with high-risk pregnancies. The aim of this study was to assess the impact of UPFconsumption on weight outcomes in the mother-child binomial of women with Gestational Diabetes Mellitus (GDM). This is an observational, prospective cohort study of 140 women diagnosed with GDM and their newborns, treated at the Januario Cicco Maternity School in Natal, Brazil. Data collection included sociodemographic characteristics, clinical and obstetric data, anthropometric data and food consumption, collected at three points in time: the first from the second gestational trimester (T1), the second in the thirdtrimester (T2) and the last in the immediate postpartum period (T3). Food consumption was obtained using a 24-hour recall and food was categorized according to the Nova classification. Weight outcomes in the mother-child binomial were assessed by gestational weight gain (GWG) at T1 and T2, total GWG (T3) and assessment of birth weight for gestational age. The mother- child binomials were grouped by tertiles of UPF grams and, secondarily, by tertiles of UPF calorie intake. The results of the multiple linear regression models and generalized linear models with Poisson adjustment were analysed to ascertain the association between UPF consumption in grams and maternal and infant weight outcomes, with adjustments for confounding variables. The significance level assigned to the tests used was p<0.05. Energy consumption was 1960.72 (±460.73) calories, with a PSA contribution of 17.95% (95% CI = 16.24 - 19.66). Most of the women started pregnancy obese (57.10%). The BW at T1 was 4.36 (±5.97) kg and at T2 4.44 (±7.27) kg, showing a rapid cumulative gain in 57.10% and 47.60% of the pregnant women, respectively. The total GPG (T3) was 6.86 (±6.78), and they were classified as having a high GPG (50.70%). As for the newborns, the average birth weight was 3133.17 (±466.29), with the majority being classified as having an adequate birth weight (91.10%). The multiple linear regression models showed a positive relationship between a higher share of UPF in grams in the pregnant women's diet and cumulative and total FGW (β = 0.014; p = 0.002 and β = 0.015; p = -0.023, at T1 and T3, respectively). While the generalized linear models with Poisson adjustment showed that when grouped in the highest tertile of UPF consumption in grams, there was an increase of 3.424 in the risk of high birth weight (RR = 3.424; 95%CI = 1.068 - 10.974; p = 0.038). In conclusion, the results of this study were sensitive to infer that the consumption of UPF has an impact on maternal and infant weight outcomes in women with GDM, and it is important to discourage a diet composed of UPF at this stage.

2023

	Dissertations
1	MARIA LETÍCIA DE LIMA MACHADO COMPARISON OF HISTOPATHOLOGICAL FINDINGS IN PLACENTAS FROM PARTURIENTS INFECTED OR NOT BY SARS-COV-2. Advisor : RICARDO NEY OLIVEIRA COBUCCI COMMITTEE MEMBERS : DEBORAH DE MELO MAGALHÃES PADILHA MARCELA ABBOTT GALVAO URURAHY RICARDO NEY OLIVEIRA COBUCCI Data: Jan 18, 2023 Show Abstract The immune response of pregnant women with COVID-19, as well as the histopathological changes in the placenta caused by the infection, have not yet been elucidated. The characterization of lymphocyte subpopulations and natural killer (NK) cells, via flow cytometry, in the peripheral blood of pregnant and postpartum women infected or not by SARS-CoV-2, together with placental histopathological analysis, can contribute with more evidence on the effects caused by COVID-19 during the puerperal pregnancy period. In this cross-sectional study, the peripheral levels of total T lymphocytes, TCD4+ lymphocytes (ThL), TCD8+ lymphocytes (TcL), B lymphocytes and NK cells, in pregnant and postpartum women with positive and negative PCR for SARS-CoV-2 were compared. In addition, a comparison of placental histopathological findings was performed, using the Hematoxylin/Eosin staining method, of part of the parturients included in the study. The collection of peripheral blood and placental tissue samples took place between May 2021 and March 2022, in a teaching hospital in the northeast region of Brazil. Immunophenotyping was performed in 99 women, of which 78 (78.8%) had a confirmed diagnosis of COVID-19. Pregnant women and postpartum women infected with SARS-CoV-2 had higher levels of cytotoxic T cells, median (ME) = 574.2; interquartile range (IIQ) = 382.4, when compared with uninfected patients, ME = 404.7; IIQ = 363.5); p = 0.032. Histopathological analysis was performed on 30 placentas, of which 10 parturients had a diagnosis of COVID-19 confirmed by PCR (33.3%). Results revealed higher levels of congestion, focal chronic villitis, and acute funisitis in placentas from COVID-19 positive parturients. Negative parturients had a higher percentage of intervillous hemorrhage with thrombus formation, dystrophic calcification, placental infarction except marginal and acute capsular deciduitis. However, there was no statistically significant difference between the groups, nor a predominant histopathological pattern in pregnant women infected by the virus in the sample studied for comparison of placental findings. Pregnant women and postpartum women with COVID-19 had significantly higher levels of cytotoxic T cells in peripheral blood, but there was no difference in placental histopathological findings, although the group with confirmed infection had a higher percentage of congestion, focal chronic vilitis and acute funisitis.
2	JESSICA DAYANNA LANDIVAR COUTINHO Clinical, sociodemographic and behavioral indicators in Genetic Counseling in Oncology. Advisor : DANIELLA REGINA ARANTES MARTINS SALHA COMMITTEE MEMBERS : DANIELLA REGINA ARANTES MARTINS SALHA ANA KATHERINE DA SILVEIRA GONCALVES DE OLIVEIRA KLEYTON SANTOS DE MEDEIROS Data: Mar 23, 2023 Show Abstract Genetic counseling (GC) has become a pivotal health preventive strategy service to manage high-risk patients for hereditary cancer in the genomic era. Identifying high-risk cancer variants in asymptomatic carriers and controlling their risk has been shown to reduce breast cancer and mortality. Brazil is a continental middleincome country with an admixture population that are suggested to have the highest internal genetic variation of sampled populations. The present study aims to evaluate clinical, sociodemographic and behavioral indicators in high-risk patients undergoing GC for hereditary cancer since 2009, in a cancer care hospital. The service has received 139 patients, where 63.3% of patients did not have higher education, 69.3% had less than 60 y; 91% had breast cancer as a primary diagnosis and 23.7% carries a germline variant in high-risk genes. The 5 years overall survival was 88.6%, with no significant difference between patients with germline mutation (95% CI, p = 0.138). After GC, 90.9% and 73.3% of the patients had mild/normal score for depression and anxiety, respectively, and regardless of age at diagnosis. Moreover, the decision of undergoing risk-reducing mastectomy (RRM) was not influenced by the depressive or anxious symptoms. However, 44.4% of women aged more than 60y did not present willingness to undergo RRM. Among patients with pathogenic variant, 58% state that the diagnosis of germline mutation was able to modify unhealth habits, 91.7% of the women could understand the meaning of germline mutation and the implications to their and family’s health, however, this was directly related to the education level. These results reaffirm the challenges of GC in an underdeveloped region of the country with high parental consanguinity, phenotypic heterogeneity and highlight the cancer health disparity that exists for the high-risk population.
3	FERNANDA CATARINA RIBEIRO COMPARATIVE ANALYSIS OF THE EFFECTIVENESS OF TOPICAL AND ORAL POLYPHENOLS ON SKIN AGING IN WOMEN: A SYSTEMATIC REVIEW. Advisor : RAND RANDALL MARTINS COMMITTEE MEMBERS : RAND RANDALL MARTINS RODRIGO DOS SANTOS DINIZ FRANCISCA SUELI MONTE MOREIRA Data: Apr 26, 2023 Ata de defesa assinada: Show Abstract Introduction: Skin aging in women is mainly correlated with exposure to solar radiation with menopausal events, such as hypoestrogenism. In parallel with the increase in life expectancy, both are associated with the induction of oxidative stress, motivating the signs and symptoms of senescence. The development of phytotherapics based on polyphenols can minimize the unwanted effects of skin wear, highlighting flavonoids. Despite its probable beneficial potential, there are limitations in the literature. Objective: To develop a systematic review of clinical trials, addressing the effectiveness of polyphenol compounds in delaying skin aging in women, comparing oral and topical routes. Methodology: A literature search was carried out in the electronic databases MEDLINE (via PubMed), Cochrane, Embase and Web of Science, published between the years 2012 and 2022. Eligible studies were randomized, double-blind, controlled trials, with the exception of one study that did not include a comparator group. Studies were selected that evaluated the effectiveness of an isolated or combined herbal medicine, which reported the following outcomes: elasticity (R2) and roughness or volume of wrinkles (visiometer or Primos). Results: After retrieving the articles, 13 studies were selected, with a total number of participants ranging from 20 to 120 individuals, composed of healthy women aged between 30 and 65 years, with the predominant inclusion criterion being the presence of wrinkles (usually the Wrinkles score ≥ 3) and with intervention protocol applied on the face. Four studies with low risk of bias and high heterogeneity regarding the plants used were identified. Favorable results were shown in elasticity and roughness, being attested after eight weeks of topical administration, and twelve orally. Conclusion: We emphasize that herbal medicines based on polyphenols have a positive impact on skin elasticity and roughness. In addition to the biomolecule, we emphasize the importance of time and route of administration to achieve the expected effect, since the topical route revealed brevity in the response compared to the oral route. Furthermore, we identified in the literature the diversity of tested compounds and methodological weaknesses, making more methodologically consolidated tests necessary.
4	LISIEUX DE LOURDES MARTINS NOBREGA LASERTHERAPY IN THE TREATMENT OF GENITOOURINARY SYNDROME OF MENOPAUSE: SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CLINICAL TRIALS. Advisor : RICARDO NEY OLIVEIRA COBUCCI COMMITTEE MEMBERS : RICARDO NEY OLIVEIRA COBUCCI MARIA THEREZA ALBUQUERQUE BARBOSA CABRAL MICUSSI MARIA IRANY KNACKFUSS Data: Apr 27, 2023 Show Abstract Laser therapy has been proposed to improve the symptoms of genitourinary syndrome of menopause (GSM), especially in women who do not accept or have a high risk of complications if they undergo hormonal therapy. However, studies evaluating the efficacy and safety of laser treatment for GSM have shown controversial results. Therefore, the objective of the study is to evaluate the effects of laser therapy in menopausal patients with GSM. A systematic review and meta-analysis of randomized clinical trials (RCTs) was carried out based on a protocol published in a scientific journal, prospectively registered through the International Prospective Register of Systematic Reviews (PROSPERO/CRD42021253605) and following the Preferred Reporting Items for Systematic Review and Meta-analysis Protocol, using the PICOS strategy to find studies with postmenopausal women without treatment, or undergoing laser therapy, placebo, or vaginal estrogen for GSM. According to the protocol, randomized and quasi-randomized clinical trials, regardless of the language of publication, were searched in databases using keywords, and 12 were included whose results were systematically evaluated for vaginal atrophy, pH, dryness, dyspareunia, itching, burning, dysuria, frequency, urgency, and urinary incontinence. The review provided evidence that carbon dioxide (CO2) laser increases the Vaginal Health Index (VHI) score and decreases dyspareunia, dryness, and burning, especially when compared to placebo, but with low certainty of evidence.
5	STEPHANY ANN COSTA ROSARIO Association of the presence of proteinuria in preeclampsia with the maternal and neonatal outcomes. Advisor : MARCELA ABBOTT GALVAO URURAHY COMMITTEE MEMBERS : MARCELA ABBOTT GALVAO URURAHY DANIELLA REGINA ARANTES MARTINS SALHA JEFFERSON ROMÁRYO DUARTE DA LUZ Data: May 11, 2023 Show Abstract Preeclampsia (PE) for a long time was diagnosed based on the triad of edema, proteinuria and hypertension; with the advance of studies, edema and proteinuria became criteria related to severity and not necessarily to diagnosis, thus the presence of hypertension together with isolated proteinuria are not decisive criteria for the diagnosis of PE. In this sense, this study aimed at identifying the correlation between worsening of the clinical picture of pregnant women diagnosed with preeclampsia and neonates, considering that proteinuria is nowadays an unnecessary diagnostic criterion for the disease. This is a longitudinal, prospective, observational study carried out from January to October 2022 at the Januário Cicco Maternity School. The study population consisted of 32 pregnant women and their newborns (NB), classified according to the assessment of qualitative proteinuria in the strip, being Proteinuria negative or traces (n=13) and Proteinuria ≥ 1+ (n=19). Blood samples were collected from fasting pregnant women in a tube without anticoagulant for biochemical evaluation (10ml), analyzed using the Dimension RxL equipment (Siemens, São Paulo, SP, Brazil) and collected (4ml) in a tube with anticoagulant ethylenediaminetetraacetic acid (EDTA) in order to assess hematological parameters, analyzed by Advia 2120i equipment (Siemens, São Paulo, SP, Brazil). Proteinuria was measured at admission by qualitative evaluation in isolated urine sample (Uri-Color Check reactive strip from WAMA Diagnóstica, São Carlos, SP, Brazil). Data were collected from the electronic medical records of pregnant women and their respective neonates in the University Hospitals Management Application (AGHU). The distribution of continuous variables was assessed by the Shapiro-Wilk test, and all variables were considered nonparametric. Non-parametric data were analyzed by the Mann-Whitney test and correlated by Spearman. Regarding differences between categorical variables, these were tested by chi-square analysis. The evaluations were performed using SPSS Statistics version 20.0 (IBM, New York, USA). P values lower than 0.05 were considered statistically significant. Among the results obtained we can highlight that 28 (87.5%) of the pregnant women were admitted to the high-risk sector, 12 (92.3%) from the negative or trace proteinuria group and 16 (84.2%) from the proteinuria ≥1+ group, the predominant route of delivery was cesarean section, most of the NB presented prematurity, low birth weight, and most of them required hospitalization (p=0.007). In addition, 15 (78.9%) RNs in the proteinuria ≥ 1+ group required ventilatory support (p=0.020). Differences were observed between groups regarding diastolic blood pressure at the time of delivery (p<0.018), uric acid (p<0.012), urea (p<0.030), AST (p<0.001), ALT (p<0.033), LDH (p<0.005), total protein (p<0.004), albumin (p<0.001). The main positive correlations observed were between maternal age and total proteins (r=0.404; p<0.024), birth weight and total protein (r=0.511; p<0.009) and LDH and AST (r=0.727;p=0.001), the negative correlations observed were blood pressure at delivery and total proteins (r=0.670; p=0.001), total proteins and AST (r=0.719;p=0.001), albumin and AST (r=0.728;p=0.001), Albumin and total proteins (r=0.882;p=0.001), urea and GI at birth (r=0.721;p=0.001), Urea and birth weight (r=0.667;p<0.001).Thus, proteinúria was associated to poorer mother and neonatal outcomes.
6	MARIA APARECIDA FELICIANO DE SOUZA Dual-stainig expression of p16/ Ki-67 in liquid-based cytology in cervical cancers: a scoping review. Advisor : JANAINA CRISTIANA DE OLIVEIRA CRISPIM FREITAS COMMITTEE MEMBERS : DEYSE DE SOUZA DANTAS JANAINA CRISTIANA DE OLIVEIRA CRISPIM FREITAS KLEYTON SANTOS DE MEDEIROS Data: Oct 16, 2023 Show Abstract This review aims to present an overview of p16/Ki-67 dual-staining (DS) expression in Liquid Based Cytology (LBC) in samples from patients with cervical cancer (CC). Material and Methods: This scoping review was developed following the guidelines for systematic reviews and meta-analyses for scoping reviews (PRISMA-ScR). A literature search using PubMed, Lilacs, Web of Science and Scopus electronic databases was conducted to identify studies that used DC for expression of p16/Ki-67 in CC in immunocytochemistry in LCB. The process of selecting and extracting data in a paired and independent way. The quality of included studies was assessed using the Joanna Briggs Institute Levels of Evidence. The review was registered in the Open Science Framework (OSF): DOI 10.17605/OSF.IO/9MUBQ. Results: Of the 149 studies analyzed, 7 studies, published between January 2018 and May 2023, were included in the qualitative synthesis. As expression parameters, p16/Ki-67 has been reported for DS in CBL in CC. Furthermore, we found that p16/Ki-67 in the CBL sample were expressed in squamous cell carcinoma (SCC). Conclusions: The study suggested that DC p16/Ki-67 is more frequently related to the CC group when compared to the HSIL and NILM group.
7	SUERDA EMILIANA CAVALCANTI DANTAS Situational diagnosis of surgical congenital heart diseases in the state of Rio Grande do Norte. Advisor : VIVIANE SOUZA DO AMARAL COMMITTEE MEMBERS : CIPRIANO MAIA DE VASCONCELOS DANIELLA REGINA ARANTES MARTINS SALHA VIVIANE SOUZA DO AMARAL Data: Oct 20, 2023 Show Abstract Introduction - Congenital heart defects are the most common congenital anomalies and account for 8% of infant mortality, causing a great impact on morbidity and mortality in the pediatric age group. However, in Brazil, underreporting of cardiac malformations suggests that the diagnosis is made late, which prevents early surgical treatment. In Rio Grande do Norte (RN) the dimension of this situation is unknown, requiring greater detail, so that public policies to reduce morbidity and mortality due to cardiac malformations can be implemented at the state level. Given this scenario, the objective of this study was to describe the prevalence of surgical congenital heart defects in children from the cases observed at Hospital Rio Grande, the only reference center in pediatric cardiac surgery in the state. Methodology - After approval by the Research Ethics Committee, a cross-sectional study was started with analysis of electronic medical records of patients with surgical congenital heart disease admitted to the state's pediatric cardiology ICU, which operates at Hospital Rio Grande, from October 2018 to December 2022. The collected data were analyzed, firstly, through descriptive statistics using the JAMOVI 2.3.21 software. The frequency of cases by municipality and Health Region (HR) was represented by maps, using the Qgis 3.22.6 software. A generalized linear model using binomial distribution was also performed. Results –There were 594 admissions of children, with a mean age at admission of 2 years and 1 month, with 86% of the procedures performed by the SUS. It was observed that 41.7% of the patients resided in the VII HR, which includes the state capital and adjacent municipalities. There was a higher prevalence of surgical congenital heart diseases in the Health Regions located in the territorial strip to the south of the state. There was a predominance of procedures classified as severity score RACHS-1 categories 2 (38.6%) and 3 (33.7%). There were 59 deaths, 77.9% of which were patients with cyanotic defects, with a mean age of 6.9 months. Higher mortality was observed in category 6 RACHS-1 procedures. Risk factors for postoperative death were length of stay in the ICU (p<0.001), level of surgical complexity (p<0.01), need for reoperation (p<0.005) and diagnosis of cyanotic heart disease (p<0.05). On the other hand, municipal HDI and distance to the service were not associated with risk of death. The total length of hospital stay was a protective factor for death. Evaluation of DATASUS data from 2019 to 2022 indicated a scenario of underreporting and deficit of surgical procedures in RN. Conclusion – The results found serve as potential support for the development and implementation of public policies that allow improving care for children with heart defect, from prenatal care to clinical and surgical treatment, in the state of RN and in other locations in Brazil. Furthermore, the finding of a specific territorial area with a higher prevalence of surgical congenital heart disease calls for further investigation into the genetic and environmental factors involved in the etiology of congenital heart defect in this region and in adjacent territorial areas of the semi-arid region in other states.
8	ANDREIA SUELLE MOURA FONSECA Trigger tool for optimizing pharmacotherapeutic follow-up in high-risk pregnant women: development and validation. Advisor : RAND RANDALL MARTINS COMMITTEE MEMBERS : FRANCISCA SUELI MONTE MOREIRA RAND RANDALL MARTINS RODRIGO DOS SANTOS DINIZ Data: Oct 25, 2023 Show Abstract Introduction: clinical pharmacy seeks to improve pharmacotherapy care and uses strategies and tools for this purpose. However, there are no tools aimed at pharmaceutical care for high-risk pregnant women. Objective: to develop and validate a trigger tool to optimize the identification of drug-related problems (DRP) in hospitalized pregnant women. Methods: descriptive observational study developed in a Brazilian maternity hospital from September 2019 to July 2022. Based on the profile and frequency of prescription, the main parameters for monitoring effectiveness and safety were used to develop triggers. The trigger tool was validated with 150 pregnant women simultaneously evaluated using the SOAP method by two groups: test group (only applied the SOAP method if at least one positive trigger) and standard group (all patients evaluated). The investigation involved identification and characterization of PRMs via PCNE. The tool was characterized in terms of accuracy, sensitivity, specificity and predictive values, in addition to using the Brier method for validation. Results: The trigger tool had a sensitivity of 74.1% (95%CI 67.7 - 81.1), specificity of 70.7% (95%CI63.4 - 78.0) and accuracy of 73.2% ( 95%CI65.3 - 79.7). Internal validation showed a Brier score of 0.269. Conclusion: The evaluated tool showed moderate sensitivity and predictive value acceptable positive, making it a useful tool in the initial screening and identification of possible DRPs in patients.
9	RENATA POLLIANA DE OLIVEIRA NASCIMENTO EFFICACY OF PHYSIOTHERAPY FOR TREATING VULVODYNIA: A SYSTEMATIC REVIEW Advisor : ANA KATHERINE DA SILVEIRA GONCALVES DE OLIVEIRA COMMITTEE MEMBERS : ANA KATHERINE DA SILVEIRA GONCALVES DE OLIVEIRA MICHELLY NOBREGA MONTEIRO ANA PAULA FERREIRA COSTA Data: Oct 27, 2023 Show Abstract Background: Vulvodynia is described as pain in the vulvar region that impacts dramatically women's lives leading to sexual dysfunction, reduction in self-esteem and decrease in the quality of life. Neurologic (central and peripheral) mechanisms may be associated to this condition, thus systematic reviews focusing the efficacy and benefits of physiotherapy on this population are necessary for consolidated evidence to aid clinical practice. Objectives: To assess the efficacy of physiotherapy for vulvodynia. Methods: The present systematic review was designed and reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). PubMed, Embase, Scopus, Web of Science, SciELO, PEDro, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched on February 2023. Two authors selected and extracted the data independently. The risk of bias was assessed using the Cochrane Risk of Bias tool (Rob 2). Due to the high heterogeneity presented between the studies, it was not possible to carry out the qualitative analysis. The results were presented in narratively. PROSPERO registration: CRD42023394207. Results: A total of 2.274 articles were retrieved from the databases. Seven studies met the criteria and were included in a systematic review, a total of 477 patients. The interventions included were electromyography biofeedback (n= 2), Transcutaneous electrical nerve stimulation TENS (n= 1), Transcranial direct current stimulation (TDSC) (n= 1), LowIntensity Shockwave (LISWT) (n= 1), physiotherapy treatment (n= 1), and pelvic floor exercise more behavioral modifications (n= 1). Of the seven studies present in the article, all evaluated pain reduction, five evaluated sexual function, and two evaluated qualities of life. All interventions were effective for the main outcomes; only the TDSC intervention had no significant difference when compared to the placebo group (Sham). Three studies presented a high risk of bias due to the lack of studies blinding. Conclusions: The studied interventions (electromyography biofeedback, TENS, Shockwave, physiotherapy, and pelvic floor exercise) seem to improve pain, sexual function, and quality of life. However, the heterogeneity of the studies prevented the metaanalysis. Additionally, well-designed trials are needed to improve the certainty of the evidence.
10	MARCELA QUEIROZ LOPES DE MELO MARTINS Evaluation of cytokines in patients undergoing in vitro fertilization before and after ovarian stimulation protocol in women with infertility. Advisor : JANAINA CRISTIANA DE OLIVEIRA CRISPIM FREITAS COMMITTEE MEMBERS : JANAINA CRISTIANA DE OLIVEIRA CRISPIM FREITAS DANIEL CARLOS FERREIRA LANZA JULIANA MEOLA LOVATO Data: Oct 30, 2023 Show Abstract The search for biomarkers that have a predictive and prognostic value in the pathophysiology of the infertility process between couples is one of the objectives of reproductive immunobiology studies. It is known that immunoregulatory molecules and expression of pro/anti-inflammatory mediators have a contribution in reproductive medicine. However, the role of these molecules in the physio pathogenesis of infertility is still unknown. This study aims to evaluate the protein expression of the cytokine axis of Th1, Th2 and Th17 responses in women who present infertility before and after ovarian stimulation protocol. A prospective cohort pilot study was conducted with 20 women followed by the assisted reproduction outpatient clinic from September 2021 to September 2022 at a University Hospital. As an inclusion criterion, we selected women over 18 years of age diagnosed with infertility due to different etiologies and causes with clinical indication for the treatment of in vitro fertilization (IVF). Women with autoimmune diseases, immunodeficiencies, chronic diseases and genetic syndromes linked to sex chromosomes did not participate in the study. 5ml of whole blood was collected by venous puncture for the quantification of cytokines by flow cytometry at two different times: Time 0: Before the start of the ovarian stimulation protocol (without medication) and at time 1: On the day of ovarian puncture for collection of oocytes (after medication for ovarian stimulation). For statistical analysis, Spearman correlation with p<0.05 values was performed. We observed a negative correlation between the fertilization rate and the production of TNF-α (p0.041) independent of the Th17 response. In this context, we observed a modulation of the Th1 response, suggesting a contribution of the adaptive immune response, as well as modulation of pro-inflammatory cytokines in the process of oocyte maturation and fertilization, suggesting a contribution of the immune response in fertility. Strategies to regulate this immunomodulation are still poorly studied.
11	AMANDA GABRIELA ARAUJO DA SILVA ASSOCIATION BETWEEN THE CONSUMPTION OF ULTRA-PROCESSED FOODS AND THE GLYCEMIC PROFILE OF WOMEN WITH GESTATIONAL DIABETES MELLITUS AND THEIR NEWBORN Advisor : KARLA DANIELLY DA SILVA RIBEIRO RODRIGUES COMMITTEE MEMBERS : KARLA DANIELLY DA SILVA RIBEIRO RODRIGUES DANIELLE SOARES BEZERRA FERNANDA RAUBER Data: Nov 29, 2023 Show Abstract The high consumption of ultra-processed foods (UPF) has caused unfavorable effects on the health of the population and on the nutritional quality of the diet, however, there are still few studies that evaluate the impact of this consumption on metabolic outcomes of mother-child pairs in Gestational Diabetes Mellitus (DMG). Thus, the objective of the study was to evaluate the association between UPF consumption and the glycemic profile of women with GDM followed at a high-risk prenatal clinic and the occurrence of hypoglycemia in their newborns. The study was observational, longitudinal, prospective, cohort, with women diagnosed with GDM and their newborns. Data collection took place at least two times during prenatal care (during the 2nd and 3rd trimester of pregnancy) and immediately after birth. The assessment of food consumption was carried out according to the NOVA classification, with pairs grouped according to tertiles of energy contribution of UPF in the diet. The glycemic profile was assessed by fasting blood glucose, self-monitoring of capillary blood glucose (fasting, one hour after breakfast, one hour after lunch and one hour after dinner) in pregnant women, and according to capillary blood glucose levels in their newborns in the first 48 hours of life. Binary logistic regression analyzes were performed to evaluate the relationship between the increase in UPF participation, considering the highest tertile of UPF consumption as a reference category, in the control of glycemia in women with GDM at the time of the research and the occurrence of hypoglycemia in their neonates (<50 mg/dL). 94 couples participated in the study, whose average caloric intake for women was 1,936 Kcal (1228 - 3124 Kcal), with 15% of the energy coming from UPF. Regarding the glycemic profile, 33.3% (n=30) and 52.3% (n=45) of them presented hyperglycemia in the second and third trimester of pregnancy, respectively. It was observed that UPF consumption had no significant association with maternal glycemic control, but showed a positive association with the occurrence of neonatal hypoglycemia (OR: 1.14; 95% CI: 1.037-1.262; p=0.007). Thus, the data suggest that the consumption of UPF can impact the occurrence of neonatal hypoglycemia in newborns of high-risk pregnant women, reinforcing the inclusion of guidelines for promoting healthy eating during pregnancy in nutritional assistance protocols for pregnant women with GDM.
12	HÍVILA NAYANNA DA SILVA MOREIRA Wilms’ Tumour 1 as biomarker in preeclampsia. Advisor : MARCELA ABBOTT GALVAO URURAHY COMMITTEE MEMBERS : MARCELA ABBOTT GALVAO URURAHY VICTOR HUGO REZENDE DUARTE JEFFERSON ROMÁRYO DUARTE DA LUZ Data: Dec 21, 2023 Show Abstract Preeclampsia (PE) is a pregnancy multisystemic injury characterized associated to hypertension, since the 20th week of pregnancy. Other signal and symptoms may be present, including proteinuria, thrombocytopenia, and/or hemolysis, kidney and liver injury, epigastric pain, headache and visual injuries. According to the moment of onset, PE may be classified in early or late, with different associated pathophysiological processes. In recent years, studies of PE related kidney damage have shown an association with podocytes. Therefore, podocyte biomarkers, such as Wilms’ Tumour 1 (WT-1), have been studied. Given this, the present study sought to evaluate the expression of WT-1, present in urinary extracellular vesicles (EVs), in order to investigate its potential as a biomarker in pre-eclampsia. 23 pregnant women with preeclampsia and 9 normotensive pregnant women were included in the study. Pregnant women with PE were also classified according to the period of development of PE, as well as whether they had resistant hypertension or not. Quantification of WT-1 present in EVs was performed by Western-blot, after isolation of the vesicles by ultracentrifugation. In addition, serum biochemical parameters were determined and demographic data was collected to characterize the studied population. Although significant differences were found for WT-1 in the PE groups compared to the control group, no difference was observed between the PE groups. Thus, it is suggested that WT-1 has potential as a disease marker.
13	MARIA CLARA DE ARAUJO SILVA CAVALCANTI Association between 25-hydroxyvitamin D concentrations in pregnant women with preeclampsia and neonatal outcomes. Advisor : MARCELA ABBOTT GALVAO URURAHY COMMITTEE MEMBERS : ANNA CHRISTINA DO NASCIMENTO GRANJEIRO BARRETO DANIELLA REGINA ARANTES MARTINS SALHA MARCELA ABBOTT GALVAO URURAHY Data: Dec 22, 2023 Show Abstract Preeclampsia is a multifactorial and multisystem disease, specific to pregnancy, which manifests itself in previously normotensive pregnant women after the 20th week of pregnancy. Due to its systemic character, it is associated with maternal, perinatal and neonatal severity situations. Hypovitaminosis D is related to preeclampsia, increases the risk of premature birth, low birth weight, metabolic bone disease, bronchopulmonary dysplasia, respiratory distress syndrome and neonatal sepsis, suggesting a protective role for this vitamin in the maternal-fetal interface. The aim of the study is to determine the association between 25-hydroxyvitamin D concentrations in pregnant women with preeclampsia and neonatal outcomes. So far, 7 pregnant women and their newborns have been included in the study, whose mothers, aged over 18 years, were previously diagnosed with preeclampsia and were followed up by the research group. Vitamin D was measured by chemiluminescence and data collected from electronic medical records. For statistical analysis, Spearman's aid was applied. For continuous variables, the median value was determined within the interquartile range referring to the 25th and 75th percentiles. P value < 0.05 was considered statistically significant. As the maternal profile data had a mean age of 28.4 years. The pregnant women's body mass index was classified as obese and the average time of sun exposure was 2.7 hours. The mean serum concentration vitamin D in pregnant women was 29.1 ng/mL. All newborns were born by cesarean delivery, 57.1% were female, gestational age and mean birth weight were 35.4 weeks and 2580g, respectively. All RNs were admitted to the MEJC. The mean length of stay in the NICU and in the other wards was 32.3 and 7.4 days, respectively. No deaths were recorded among maternal and neonatal participants. Due to insufficient sample size to date, it has not been possible to correlate maternal vitamin D levels with preeclampsia and neonatal deaths. Thus, the characterization of the sample was carried out.

2022

	Dissertations
1	MAIARA COSTA DE OLIVEIRA Rumo À Maternidade: Validation Of A Telemonitoring Mobile Application For Pregnant Women. Advisor : MARIA THEREZA ALBUQUERQUE BARBOSA CABRAL MICUSSI COMMITTEE MEMBERS : MARIA THEREZA ALBUQUERQUE BARBOSA CABRAL MICUSSI ANNA GISELLE CAMARA DANTAS RIBEIRO RODRIGUES BELISA DUARTE RIBEIRO Data: Sep 27, 2022 Show Abstract Pregnancy, the latent phase of labor, labor, and the puerperiumare are periods ofincreased expectancy not only of the woman but also of the complete family. Thisphase of life is expected to be marked by anxiety, which may favor the anticipation ofhospital departure before the active phase of labor. Therefore, this study aimed todevelop and validate a telemonitoring mobile application for pregnant women in theirlast gestational trimester. This validation study involved 40 volunteers, of whom 10were obstetrician professionals, 10 were professionals of technology, and 20 werepregnant women of at least 36 weeks of gestation. The health professionals evaluatedthe app content through the Content Validity Index, the technology professionalsthrough the software appearance questionnaire, and the pregnant volunteers throughthe System Usability Scale to evaluate the app usability. The “Rumo à maternidade”app was developed with React Native technology and is composed of three interfacesas follows: Educational, Symptoms Record, and My Pregnancy. The final score of theContent Validity Index was 0.91 for content and 0.78 for appearance. Additionally,the usability score was 0.85. Once all obtained scores were in the expected range forthe app usage, additional interviews were not necessary. To conclude, the mobile app“Rumo à Maternidade,” which was developed and validated in the Portugueselanguage in Brazil, is a helpful tool with good usage acceptance to promote healtheducation during the third trimester of pregnancy and facilitate labor identification.
2	JÉSSIKA ALINE DO NASCIMENTO MEDEIROS Characterization of Th17, Th1 and Th2 axis cytokine profile and gene polymorphism in patients with cervical cancer. Advisor : JANAINA CRISTIANA DE OLIVEIRA CRISPIM FREITAS COMMITTEE MEMBERS : JANAINA CRISTIANA DE OLIVEIRA CRISPIM FREITAS PAULA RENATA LIMA MACHADO MARCIA EDILAINE LOPES CONSOLARO Data: Oct 24, 2022 Show Abstract Cervical cancer (CCU) is a public health problem that affects many women around the world and its etiology and pathogenesis are intrinsically linked to Human Papillomavirus (HPV), representing the fourth cause of death among women. Estimates report that about 80% of sexually active women will acquire an infection in their lifetime. It is known that the host's immune system, in most cases, is able to eliminate the HPV virus, but in some cases the patient will develop a persistent infection, which will culminate in the emergence of cervical cancer. Considering the importance of the immune system in this process, it is necessary to understand the cells and mechanisms involved. Therefore, evaluating the T helper cell pattern 1, 2 and 17 (Th1, Th2 and Th17) via cytokine quantification and associating the gene polymorphism of the IL-17-RA17 axis is the objective of the present study. This is a case-control observational study, with retrospective data and samples acquisition, having been collected from 2015 to 2019, and the study population consisted of 428 samples from a group of patients with indication of intraepithelial lesion and cervical cancer at the Cervical Pathology and Oncology outpatient clinic of the Januário Cicco Maternity School and the Hospital Luiz Antônio da Liga Contra o Câncer, they were stratified into 104 (24 %) with cervical cancer (CC), 125 (29 % ) with high-grade lesions, 86 (20%) with low-grade lesions, 104 (24%) were NILM, and 9 (3%) had indeterminate lesions, and the patients identified as NILM were classified as controls in this study. The execution of this work involves carrying out the gene polymorphism of IL17A and IL17RA in the following steps: DNA extraction and quantification; Polymerase Chain Reaction (PCR); and electrophoresis, while cytokine quantification was performed using the BD™ Cytometric Bead Array (CBA) Human Th1/Th2/Th17 cytokine kit. In our series, the data showed that there seems to be no association between the gene polymorphism of the IL-17-RA17 axis and the diagnosis of CC, in addition, in our study, the cytokines presented values below the detection limit, which can be justified by the action of HPV being a little cytopathic virus, imperceptible to the immune system.
3	ARTHUR NORONHA COSTA DO NASCIMENTO PERINATAL TRANSMISSION OF CYTOMEGALOVIRUS IN PREMATURE NEWBORNS THROUGH BREAST MILK Advisor : PAULA RENATA LIMA MACHADO COMMITTEE MEMBERS : PAULA RENATA LIMA MACHADO NAYARA GONÇALVES BARBOSA KLEBER JUVENAL SILVA FARIAS Data: Oct 27, 2022 Show Abstract Human cytomegalovirus (CMV) is a double-stranded linear DNA virus and has a wide distribution worldwide, with its seroprevalence varying according to several epidemiological factors. Breastfeeding represents an important route of transmission of several infections from mother to child, including perinatal CMV infection. The present study is justified by the need for studies that address the incidence of cases of perinatal transmission and the correlation with risk factors and clinical outcome of premature neonates, contributing to the best decision to be made regarding breastfeeding, weighing the risks and benefits and, therefore, adopting the best medical conduct in Neonatal Intensive Care Units (NICU) regarding the safety of breast milk. The overall objective of this study was to evaluate the perinatal transmission of CMV in premature newborns (NB) from a NICU through breastfeeding. The study was observational, longitudinal cohort, prospective, involving premature newborns admitted to the NICU of the Januário Cicco Maternity School (MEJC) during the period from September 30, 2021 to June 2, 2022 with gestational age less than 33 weeks or birth weight less than 1500g, excluding cases of severe birth defects. All mothers underwent postpartum blood draws and were tested for CMV seropositivity. The biological samples of preterm infants' urine and breast milk were submitted to molecular biology techniques (extraction, PCR, and electrophoresis). Clinical and laboratory data were obtained from medical records obtained by the Neonatology team of the maternity ward. Partial results showed seropositivity for IgG anti-CMV antibodies in 76/77 mothers (98.70%) and IgM in 3/77 patients (3.90%). The rate of virus detection in breast milk was analyzed in 21/63 (33%) mothers with available milk samples. The incidence of perinatal infection via breast milk was analyzed in 3/45 (6.66%) RNs with available urine samples. It was not possible to associate perinatal infection with clinical symptoms and risk factors for disease development due to the limited incidence of perinatal infection cases.
4	AURORA TATIANA SOARES DA ROCHA Success prediction in inserted of the peripherally central catheter insertion in newborns. Advisor : SILVANA ALVES PEREIRA COMMITTEE MEMBERS : SILVANA ALVES PEREIRA CECILIA OLIVIA PARAGUAI DE OLIVEIRA SARAIVA EDIENNE ROSANGELA SARMENTO DINIZ Data: Oct 31, 2022 Show Abstract Introduction: Newborns in critical condition hospitalized in Neonatal Intensive Care Units often need prolonged intravenous therapy for the recovery of their health and the peripherally inserted central catheter is the most indicated for the safe infusion of these solutions. However, the placement of this catheter in newborns can be difficult, becoming a challenge for the nursing team, predisposing the baby to multiple peripheral punctures, stress and pain. A particularly important aspect for this population is the lack of data on prediction equations for successful insertion of this device. Thus, this study aims to develop a prediction equation for success in peripherally inserted central catheter insertion in newborns. Methods: This is an observational, retrospective study carried out with the medical records of newborns admitted to the neonatal intensive care unit who used peripherally inserted central catheters between August 2018 and July 2021, whose sample was 359 newborns. Data on duplicated or incompletely and/or incorrectly completed newborns were excluded. Catheter insertion was considered successful when the tip of the catheter was inserted into the lower third of the superior vena cava from an upper extremity and into the upper third of the inferior vena cava from a lower extremity. Binary association tests and logistic regression were applied. Variables with p<0.05 remained in the final regression model. Results: 359 newborns were included between 23 and 41 weeks (median of 31 weeks and 4 days), 284 were on mechanical ventilation (invasive or non-invasive) and 70 progressed to successful PICC insertion. Being extremely premature, very premature and premature reduced the probability of PICC success by an average of 31.2% (95%CI: 25.5 to 38.1%), 21.4% (95%CI: 17.8 to 25. 7%) and 16.7% (95%CI: 14.0 to 19.8%) respectively. In addition, being on invasive and noninvasive ventilation reduced the probability of PICC success by an average of 82.4% (95%CI: 72.3 to 93.9%) and 85.3% (95%CI: 75.0 to 97.1%), respectively. The newborn's weight above 1500 grams and the access performed in the upper body region favored the success of the PICC in 2.5 and 2.93 times, respectively. Weight classification, gestational age, insertion site and being or not on mechanical ventilation were variables that were kept in the equation. The predictive equation for PICC success found was: OR PICC success = 0.178 x (IG classification) x (region) x (sup. vent.) x (weight classification). Conclusion: Gestational age classification and being on mechanical ventilation reduce the probability of successful introduction of PICC. While weight > 1500 grams and insertion of the catheter in the upper region increase the chance of success of the PICC. The predictive equation found is a practical and reproducible tool that can reduce the risk and complications related to unsuccessful catheter insertion.
5	IVETE MATIAS XAVIER MATERNAL/FETAL OUTCOMES IN HYPERTENSIVE PREGNANCY SYNDROMES. Advisor : ANA KATHERINE DA SILVEIRA GONCALVES DE OLIVEIRA COMMITTEE MEMBERS : ANA KATHERINE DA SILVEIRA GONCALVES DE OLIVEIRA ROBINSON DIAS DE MEDEIROS KLEYTON SANTOS DE MEDEIROS Data: Oct 31, 2022 Ata de defesa assinada: Show Abstract Objective: To assess and compare maternal/fetal outcomes among women with hypertensive disorders in pregnancy (DHGs). Methods: Cross-sectional observational study, carried out at the Januário Cicco Maternity School (MEJC). Maternity of the Federal University of Rio Grande do Norte (UFRN), a reference for the care of high-risk pregnant women. The population will be composed of women hospitalized with a diagnosis of Gestational Hypertensive Disorders. As inclusion criteria for the cohort will be adopted: All women with gestational hypertensive disorders. Will be excluded: Patients diagnosed with gestational hypertensive disorders associated with other comorbidities, smokers, chemical dependents and unable to respond to the questionnaire. Information will be collected from the medical records of women and their newborns assisted at the MEJC, from June 2020 to June 2021, after the project is registered with the Teaching and Research Management (GEP) of the MEJC and after approval by the Committee of Ethics and Research of the Onofre Lopes University Hospital (CEP/HUOL). Results: Data analysis will be performed using the SPSS 17.0 statistical software, which will be presented in the form of tables, graphs and/or tables. Pearson's Chi-square test and Fisher's exact test, when relevant, will be used to compare the results. The research will follow the ethical and legal norms recommended by Resolution 466/12 of the National Health Council. Conclusion: It is hoped, with the knowledge of the determining factors of Gestational Hypertensive Disorders, can contribute to an improvement in care, in order to reduce the occurrence of complications of these problems, benefiting the pregnant woman and the newborn, as well as the health team. , with the improvement of clinical care for the maternal/fetal binomial.
6	TATIANA CAMILA DE LIMA ALVES DA SILVA ASSESSMENT OF THE FATIGUE LEVEL OF WOMEN IN THE PUERPERIA: A COHORT STUDY Advisor : MARIA THEREZA ALBUQUERQUE BARBOSA CABRAL MICUSSI COMMITTEE MEMBERS : MARIA THEREZA ALBUQUERQUE BARBOSA CABRAL MICUSSI ADRIANA GOMES MAGALHAES GUILHERME PERTINNI DE MORAIS GOUVEIA Data: Oct 31, 2022 Show Abstract The puerperium is a period of vulnerability due to the emotional and physical changes that occur after childbirth and that can influence a woman's quality of life. In this context, the decrease in physical andmental capacity associated with a persistent lack of energy, deficiencies in concentration, decreased rest and sleep time can favor the installation of physical and mental fatigue. The prevalence and incidence of postpartum fatigue has not been studied extensively and is considered an inevitable, temporary and frequently experienced symptom. This study aims to assess the level of fatigue of women in the immediate and late postpartum period and to associate it with sociodemographic and clinical factors. Through a prospective cohort study, 469 women were recruited from a public maternity hospital in the city of Natal-RN, from May to December 2021. The evaluations took place in the immediate postpartum period (between 24-48 hours) and in the puerperium. late (in the 1st and 3rd month after delivery). An evaluation form containing information on sociodemographic, clinical, gynecological-obstetric and newborn data was applied in the first evaluation along with three questionnaires for fatigue assessment: Global Short Form of selfreported global health from the Information System of Measurement of Outcomes by patient (PROMIS-GSF); multidimensional fatigue inventory (MFI) and fatigue pictogram. These data, with the exception of sociodemographic information, were applied one month after the assessment (AV2) and three months after delivery (AV3). Descriptive analysis of variables was used with mean, standard deviation, median, 25th and 75th percentiles, absolute and relative frequencies. Repeated measures ANOVA was used to compare the results of the three fatigue assessments. The multivariate model was adjusted for independent variables with significance ≤ 0.20 in the bivariate analysis and considering the clinical relevance for the occurrence of the outcome. The most prevalent age group was 26 to 34 years old, 59.5% completed elementary school, 47.6% had a salary income of up to one minimum wage and 76.1% reported having a partner. In obstetric information, 70.6% were multiparous with a median gestational age of 38 weeks, 60.5% had normal delivery, 95.7% breastfed after delivery, and 80.2% breastfed in past pregnancies. in the three evaluations showed a significant difference in the PROMIS-GSF (p < 0.01), general fatigue domains, physical fatigue and reduced motivation of the MFI (p < 0.01) and the fatigue pictogram (p < 0.01). In AV3, the PROMIS-GSF showed an association between fatigue and premature births (RR = 1.18; 95%CI: 1.02–1.37), absence of a support network (RR = 1.14; 95%CI: 1, 02–1.27), poor breastfeeding performance (RR = 1.16; 95%CI: 1.03– 1.31) and higher body mass index (BMI), (RR = 1.01; 95%CI: 1.005 –1.018). From the analysis of the results of this study, one can observe the presence of fatigue in the immediate postpartum period and its increase over three months postpartum. Prematurity, lack of a support network, poor performance in breastfeeding and higher BMI were factors associated with the persistence of fatigue in the late postpartum period.
7	JÉSSICA ESCOREL CHAVES CAVALCANTI Adverse drug reactions in hospitalized diabetic and hypertensive pregnant women. Advisor : RAND RANDALL MARTINS COMMITTEE MEMBERS : RAND RANDALL MARTINS RODRIGO DOS SANTOS DINIZ SARA IASMIN VIEIRA CUNHA LIMA Data: Dec 6, 2022 Ata de defesa assinada: Show Abstract Introduction: Pregnant women are particularly vulnerable to adverse drug reactions (ADRs), especially those with diabetes and hypertension. The occurrence of ADRs is a problem for patient safety and quality of health care. Objective: To detect the incidence and factors associated with ADRs in hospitalized diabetic and hypertensive pregnant women. Method: Observational, longitudinal and prospective study with the aim of evaluating the incidence of ADRs in diabetic and hypertensive pregnant women, their characteristics and factors related to their occurrence, involving 572 diabetic and hypertensive pregnant women. To determine the factors associated with the ADRs, a multivariate model by logistic regression will be used. Results:The incidence rate of ADRs was 634.4 ADR per 1,000 patient days (95%CI: 522.7 - 787.1) and 21.5% of patients had at least one. Hyperglycemia, blurred vision and increased transaminases were the ADRs most related to the use of systemic corticosteroids, antimetheic and anti-nausea drugs, and centrally acting anti-adrenal drugs. Longer hospitalization time (OR 1052, 95%CI: 1010 – 1097, p = 0.016) and greater number of prescribed medications (OR 1200, 95%CI: 1099 – 1310, p < 0.001) were related to the occurrence of ADRs. Conclusion: In general, we observed that ADRs are affected in the first 24 hours and that pregnant women with longer hospital stays and using more medications are at greater risk of ADR.