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Efeitos da auriculoterapia no estresse percebido e nos níveis de cortisol salivar em trabalhadores de saúde: ensaio clínico controlado randomizado

2026-02-04T19:55:37Z

Título: Efeitos da auriculoterapia no estresse percebido e nos níveis de cortisol salivar em trabalhadores de saúde: ensaio clínico controlado randomizado Autor(es): Damasceno, Kairo Silvestre Meneses Primeiro Orientador: Pimentel, Magno Merces Weyll Abstract: Introduction: Healthcare workers are subject to work-related stressors that can lead to physical, psychological, social, and behavioral problems, making stress management at work extremely important. Integrative and Complementary Health Practices can contribute to this process, such as auriculotherapy, which demonstrates a good cost benefit ratio for controlling mental disorders such as stress and anxiety. Objectives: To evaluate the effects of auriculotherapy on perceived stress levels and salivary cortisol levels in primary healthcare workers in the municipality of Salvador, Bahia, Brazil; to identify non-pharmacological therapies used in stress management in healthcare workers and their effects on self-reported stress and physiological stress; to measure and correlate self-reported stress and cortisol levels in primary healthcare workers; to identify factors associated with perceived stress and salivary cortisol levels in primary healthcare workers; to estimate the prevalence of burnout and its associated factors in primary healthcare workers; to identify the prevalence and types of violence experienced by primary healthcare workers. Methods: Epidemiological survey followed by a randomized controlled clinical trial. A sociodemographic, occupational, and human biology questionnaire, the Perceived Stress Scale (ESP-10), and the Maslach Burnout Inventory (MBI) were applied to healthcare workers in the Family Health Strategy. Approximately 1 milliliter of saliva was also collected in Salivette® tubes to measure salivary cortisol levels. Measures of central tendency and frequencies were used for descriptive analysis, correlation measures between cortisol levels, burnout, and perceived stress; logistic regression with the dependent variable burnout (binary) and linear regression with the numerical dependent variables perceived stress and burnout dimensions were used. For the clinical trial, workers with perceived stress above the overall average and with cortisol levels above the median were randomized into two groups: auriculotherapy, with application of the therapy to the Shenmen, kidney, heart, sympathetic, and brainstem points, and a placebo group, with application to the external ear and wrist points. After 4 sessions, a paired t-test (before and after therapy) was performed in case of normal sample distribution, and the Wilcoxon test was used for non-parametric distribution. The Mann-Whitney test was also used for comparison between groups. Results: there are few studies in the literature on the use of auriculotherapy to reduce physiological and perceived stress in healthcare workers. Among the workers, 58.54% presented high perceived stress, 17.48% presented burnout, 76.4% had low professional self-esteem, 58.8% had suffered some type of violence at work, and 78.8% were dissatisfied with their economic situation. The correlation between salivary cortisol and perceived stress was positive, but weak and statistically insignificant (r = 0.036 and p-value = 0.534). Perceived stress was associated with age (β=-0.11 and p=0.001), economic dissatisfaction (β=2.98 and p<0.001), and not engaging in physical activity (β=2.29 and p=0.005). Cortisol levels were associated with not having experienced violence (p=0.038) and moderate alcohol consumption (p=0.005). Burnout was associated with age (β=-0.04 and p=0.04) and economic dissatisfaction (β=1.12 and p=0.026). The emotional exhaustion dimension of burnout was associated with age (β=-0.09 and p=0.007), economic dissatisfaction (β=3.15 and p<0.001), and having experienced workplace violence (β=2.85 and p<0.001). Low self-esteem was associated with age (β=0.06 and p=0.012) and salary dissatisfaction (β=-2.061 and p<0.001). In the clinical trial, the auriculotherapy group reduced perceived stress from 24.8±3.44 to 17.6±5.59, p<0.001. The comparison with the placebo group also showed statistical significance (p<0.001). The effect size of the therapy was considered large in relation to perceived stress (Cohen's d = 1.59). There were no significant effects in relation to salivary cortisol levels. Conclusion: Salivary cortisol levels did not have a significant correlation with perceived stress, which shows still conflicting results in the literature and the existing methodological diversity. Economic dissatisfaction was associated with perceived stress, burnout and its dimensions of emotional exhaustion and low professional self-esteem, which reflects the need for professional recognition through financial appreciation of these workers. Most workers have already suffered some type of violence in the workplace. In this context, institutional policies are urgently needed to protect these workers and the work environment. Auriculotherapy has proven effective in reducing perceived stress in primary healthcare workers and could be applied within the Brazilian Unified Health System (SUS) for stress management and quality of life at work. Editora / Evento / Instituição: Universidade Federal da Bahia Tipo: Tese

Ressonância magnética na avaliação da redução progressiva da área medular em indivíduos infectados pelo HTLV-1 com ênfase na associação entre atrofia lombar e disfunção urinária sem comprometimento motor

2026-01-16T18:25:55Z

Título: Ressonância magnética na avaliação da redução progressiva da área medular em indivíduos infectados pelo HTLV-1 com ênfase na associação entre atrofia lombar e disfunção urinária sem comprometimento motor Autor(es): Carvalho, João Marcos da Silva Primeiro Orientador: Carvalho, Edgar Marcelino de Abstract: Introduction: The primary neurological manifestation of definitive HTLV-1-associated myelopathy (HAM) is spastic paraparesis, but it occurs in only 5% of patients. In contrast, approximately 40% of individuals infected with HTLV-1 present symptoms of urinary dysfunction, including nocturia, urgency, and incontinence, which may progress to an inability to urinate. Since these patients do not exhibit motor dysfunction, they are classified as probable HAM. Thoracic spinal cord (SC) atrophy is the main abnormality observed in magnetic resonance imaging (MRI) in patients with definitive HAM, but SC damage has not been reported in patients with probable HAM. Objective: To describe spinal cord features in individuals infected with HTLV-1 through magnetic resonance imaging (MRI). Methods: HTLV-1 infection was diagnosed by Western blot, and MRI was performed using a 1.5 Tesla scanner. Atrophy was defined when the SC area was less than 25% of the intrathecal area. Results: We observed a progressive reduction in all SC area segments among HTLV-1 carriers, patients with probable HAM, and definitive HAM. Notably, 48.3% of patients with probable HAM exhibited lumbar region atrophy. Conclusion: This study demonstrates, using MRI metrics, atrophy of the lumbar SC segments in patients presenting urinary symptoms associated with HTLV-1 but without motor dysfunction. Our findings suggest that spinal cord evaluation through MRI should be considered in clinical practice for the early monitoring of HTLV-1-infected patients, especially those with probable HAM. Early detection of SC atrophy may enable timely therapeutic interventions, potentially slowing disease progression and improving clinical outcomes. The impact of SC atrophy on functionality and quality of life highlights the need for more precise diagnosis and systematic follow-up. Editora / Evento / Instituição: UNIVERSIDADE FEDERAL DA BAHIA Tipo: Tese

Avaliação de biomarcadores inflamatórios na cardiomiopatia chagásica

2026-01-14T16:08:11Z

Título: Avaliação de biomarcadores inflamatórios na cardiomiopatia chagásica Autor(es): Fernandes, Karina Garcia Primeiro Orientador: Oliveira Filho, Jamary Abstract: Background: Chagas disease (CD) is linked to an elevated stroke risk predominantly through chronic cardiomyopathy; however, mounting evidence suggests that systemic inflammatory processes also contribute to cerebrovascular events and cognitive impairment even when myocardial injury is mild. Chronic inflammation plays a central role in the pathogenesis of acute ischemic stroke and dementia, raising the hypothesis that pro-inflammatory biomarkers would be higher in CD patients than in those with other etiologies of heart failure (HF). Objective: To determine whether serum levels of five pro-inflammatory biomarkers—interleukin-6 (IL-6), matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinases-1 (TIMP-1), orosomucoid, and neprilysin—are higher in patients with Chagas-related HF compared to those with nonChagas HF. Methods: In this cross-sectional study, 173 HF patients (94 with CD and 79 with other causes) were consecutively recruited from specialty HF clinics at two university hospitals. Mean age was 55 ± 12 years, and 49% were male. HF severity was assessed by transthoracic echocardiography, and serum biomarker concentrations were measured by ELISA in blood samples drawn on the day of evaluation. Results: Although non-Chagas patients had worse ventricular function (mean LVEF 38.2 ± 15.3% vs. 53.3 ± 18.0% in Chagas; p<0.001), serum TIMP-1 was significantly higher in CD patients, with an adjusted mean difference of 2.2 ng/mL (95% CI 0.1–4.5; p = 0.037). TIMP-1 levels also correlated positively with LVEF (r = 0.32; p = 0.002), suggesting a link to subclinical myocardial remodeling. In contrast, IL-6, MMP-9, orosomucoid, and neprilysin did not differ between groups. Exploratory neuroimaging analyses further indicated that distinct patterns of MMP-9 and TIMP-1 were associated with silent infarcts and microembolic signals, pointing to different profiles of cerebral vascular injury. Discussion and conclusion: In HF patients, elevated TIMP-1 in those with CD occurs despite relatively preserved ventricular function, underscoring its role as an early fibroproliferative mediator and potential indicator of vascular risk. The dissociation between echocardiographic severity and inflammatory activation suggests that TIMP-1 may serve as a sensitive marker of subclinical myocardial and cerebral injury, with promise for guiding personalized monitoring and therapeutic strategies in Chagas disease. Editora / Evento / Instituição: UNIVERSIDADE FEDERAL DA BAHIA Tipo: Tese

Assinatura Molecular na Diferenciação da Tonsilite Viral e Bacteriana

2025-10-07T18:18:33Z

Título: Assinatura Molecular na Diferenciação da Tonsilite Viral e Bacteriana Autor(es): Moreira, Paula Milena Melo Casais Primeiro Orientador: Oliveira, Viviane Sampaio Boaventura de Abstract: Introduction: Acute tonsillitis, of viral or bacterial origin, represents a diagnostic challenge. Inadequate distinction between etiologies may lead to the overuse of antibiotics and antimicrobial resistance. Strategies that integrate microbial characterization and the local immune response may improve differential diagnosis. Objective: To identify an in situ biomarker panel capable of differentiating bacterial and viral tonsillitis. Methods: This was a cross-sectional study involving 197 patients seen at Hospital Santa Izabel (Salvador, BA) with clinical suspicion of acute tonsillitis, along with 5 healthy controls. Inclusion into groups was based on the modified Centor Score (bacterial) and the presence of upper respiratory symptoms with tonsillar signs (viral). Clinical classification was performed by emergency physicians and specialists. Patients with recent use of antibiotics, anti-inflammatory drugs, or immunosuppressants were excluded. Following collection of tonsillar swab samples, DNA and RNA were converted into cDNA, prepared using targeted panels, and sequenced on the Illumina MiSeq platform. Analyses included host filtering, quality control, taxonomic annotation, and normalization. Metagenomic analysis was conducted on the CZID platform, with abundance filtering (≥100 rPM) and exclusion of irrelevant species. Resistance genes were identified using ARIBA and ResFinder. Gene expression was evaluated using nCounter technology (NanoString). Transcriptomic analysis included differential expression (log₂), FDR correction, and functional enrichment (GO, KEGG, Reactome) via gProfiler. Data was filtered by prevalence (≥20%) and analyzed using non-parametric tests, PLS-DA, clustering, microorganism-gene correlations, and ROC/PR curves with 3-fold cross-validation. Alpha and beta diversities were evaluated using ecological metrics and PCoA. Results: A total of 46 samples were analyzed (31 viral, 10 bacterial – emergency physicians; 29 viral and 12 bacterial – specialists), along with 5 controls. Metagenomic analysis revealed a complex microbial community in both patients and healthy controls, including pathogens and commensals. There were no significant differences in alpha or beta diversity between groups. Resistance genes were detected regardless of clinical suspicion. Gene expression analysis (n=24) distinguished between acute tonsillitis groups. In bacterial cases, genes such as IL21R, CD47, ITGAM, and CD163 were upregulated, with enrichment of the MHC II pathway. In viral cases, genes such as HLA-DRB5 and TUBA3E were upregulated, with enrichment of the connexon trafficking pathway (p < 0.01). Conclusion: In situ gene expression demonstrated greater diagnostic accuracy than mere pathogen detection, showing promise in etiological differentiation. Metagenomics was limited by the inherent complexity of the analysis and the diversity of the oral cavity microbiota. Editora / Evento / Instituição: Universidade Federal da Bahia Tipo: Tese