http://www.bdtd.uerj.br/handle/1/3540 2026-10-12T03:07:19Z http://www.bdtd.uerj.br/handle/1/26271 Título: A ultrassonografia como método de avaliação da distribuição da gordura abdominal em crianças pré-púberes obesas e sua relação com as respectivas alterações metabólicas Autor: Peçanha, Arine Santos Primeiro orientador: Grisolia, Alexandra Maria Monteiro Abstract: Cross-sectional study in obese prepubescent children using ultrasound to assess abdomen fat distribution and its possible correlation with metabolic changes due to obesity. We evaluated 77 obese children (33 girls and 44 boys) and 31 eutrophic children (17 girls and 14 boys), with a mean age of 7.32 years. In all children, abdominal wall thickness (AWT) and intra-abdominal fat thickness (IAFT) were measured without prior preparation. Serum glycemia, HDL-cholesterol, triglycerides and insulin were measured for associated metabolic changes. Obese children had increased abdominal fat, with a predominance of abdominal wall thickness and no difference in the medians of the IAFT and AWT in relation to gender. A statistically significant difference was found in the correlations of medians of IAFT (mm) with altered HOMA-IR and of AWT (mm) with altered HOMA-IR and hypertriglyceridemia. Multivariate linear regression models were performed that found a statistically significant direct association between HOMA-IR and AWT. There was also a statistically significant direct association between HOMA-IR and IAFT. However, the latter loses strength and statistical significance with the insertion of the variables gender and age in the model, it is noted that there is a confounding effect between gender, age and HOMA-IR. The chi-square test found the 75th percentile for the IAFT and AWT as probable cutoff points, in relation to the altered HOMA-IR (48.1 mm and 23.1 mm, respectively). In conclusion, there is a predominance of fat accumulation in the abdominal wall and its association with altered HOMA-IR and hypertriglyceridemia, and of IAFT with altered HOMA-IR and that the cut-off points can also be considered in the clinical evaluation. Instituição: Universidade do Estado do Rio de Janeiro Tipo do documento: Dissertação 2017-01-24T00:00:00Z http://www.bdtd.uerj.br/handle/1/26239 Título: Uso Integrado do Ensaio de Fluxo Lateral Lipoarabinomanano (LF-LAM) e da Atividade da Adenosina Deaminase (ADA) no Diagnóstico da Tuberculose Pleural Autor: Azevedo, Samara Galdino Primeiro orientador: Rodrigues, Luciana Silva Abstract: Pleural tuberculosis (PlTB), a common extrapulmonary form, poses diagnostic challenges due to its paucibacillary nature. We evaluated the diagnostic performance of lateral-flow lipoarabinomannan (LF-LAM) in pleural fluid (PF) and its combination with adenosine deaminase (ADA) to improve accuracy. Cross-sectional study of 233 patients with pleural effusion (99 PlTB, 134 non-PlTB) from a high-burden area in Brazil. LF-LAM was performed on PF and serum; ADA was measured at two cutoffs (≥40 U/L and ≥25 U/L). Diagnostic performance (sensitivity, specificity, PPV, NPV) was calculated using leave-one-out cross-validation (LOOCV). LF-LAM in PF was positive in 53.1% of PlTB vs. 9.2% of non-PlTB (p<0.001), showing 53.8% sensitivity and 93.2% specificity. In serum, LF-LAM had lower sensitivity (42.3%) but similar specificity (88.0%) compared to PF (p=0.003). ADA (≥40 U/L) had 69.2% sensitivity and 94.9% specificity; ADA (≥25 U/L) had 89.0% sensitivity and 85.6% specificity. The AND combination (LF-LAM and ADA≥40) yielded 85% sensitivity, 99.2% specificity and 97.1% PPV (p<0.001 vs. either test alone), while LF-LAM and ADA≥25 showed 94% sensitivity, 97.5% specificity and 93.6% PPV (p<0.001). LF-LAM in PF showed significant agreement with ADA≥40 (kappa=0.366, p<0.001) and histopathology (kappa=0.248, p=0.003). Notably, LF-LAM detected 5 PlTB cases missed by all other methods. LF-LAM in PF is a specific test for PlTB. Combining with ADA improves diagnostic accuracy, potentially reducing the need for invasive procedures. In this high-burden setting, this approach could facilitate timely treatment initiation, though validation in larger cohorts and cost-effectiveness studies are warranted. The test's rapid turnaround time further supports its utility in resource-limited settings, though its moderate sensitivity remains a limitation. Instituição: Universidade do Estado do Rio de Janeiro Tipo do documento: Dissertação 2025-12-12T00:00:00Z http://www.bdtd.uerj.br/handle/1/26235 Título: Avaliação da equidade de raça/cor e de sexo no atendimento à síndrome coronariana aguda com supradesnível do segmento ST: um estudo de coorte no Rio de Janeiro Autor: Almeida, Eric Costa de Primeiro orientador: Albuquerque, Denílson Campos de Abstract: Despite recent public policies aimed at equalizing care for patients with ST-segment elevation myocardial infarction (STEMI), disparities persist, particularly with regard to the Black population. Several studies have shown that this group is less likely to receive timely door-to-balloon intervention and to have access to pharmacoinvasive therapy; they also have a lower likelihood of being indicated for coronary artery bypass grafting (CABG) and, when indicated, tend to experience longer hospital stays and higher morbidity and mortality rates. Socioeconomic factors are also implicated and appear to further exacerbate this disparity. This study aimed to evaluate equity in relation to race/color and sex in the care of STEMI patients. A prospective cohort study was conducted between August 2022 and August 2024, involving STEMI patients referred to a single reperfusion center. The following parameters were evaluated: administration time of thrombolytics within 30 minutes; transfer time to emergency units; the association of socioeconomic factors with care; treatment choice; in-hospital mortality; survival; and the presence of post-infarction ventricular dysfunction, according to race/color and sex.The results showed that among the 504 STEMI patients, 27.2% were female and 67.8% self-identified as Black or Brown. Thrombolysis occurred within 30 minutes in 27.2% of white patients versus 12.5% of black patients (p=0.07). Race/color emerged as an independent risk predictor, with Black patients being 2.86 times less likely to receive thrombolysis within 30 minutes compared to white patients (OR=0.349, p=0.023). Female sex was also associated with a 2.40 times lower likelihood of receiving thrombolysis within 30 minutes compared to male patients (OR=0.416, p=0.015); and considering the interaction between race/color and sex, Black women had a 5.49 times lower chance of receiving thrombolysis within 30 minutes (OR=0.182, p=0.028). The study concluded that care for STEMI patients demonstrated inequities related to both race/color and sex. The door-to-needle time exceeded the expected 30 minutes; the time to first medical contact after onset of pain showed no significant difference between groups, but there was a globally significant delay. Black patients and female patients had a lower likelihood of receiving thrombolysis within 30 minutes. The interaction between race/color and sex revealed an intersectionality pattern, with Black women having the lowest chance of receiving thrombolysis within the recommended time. Moreover, Black women, white women, and Black men had worse outcomes compared to white men. Transfer time to the reperfusion center within 24 hours was associated with education level, with illiterate patients having a lower chance of transfer compared to those with higher education. There was a greater indication of clinical treatment for Black patients to the detriment of CABG. Most of the population showed post-MI ventricular dysfunction. There was no significant difference in survival between the groups; however, female sex was associated with higher long-term mortality. Instituição: Universidade do Estado do Rio de Janeiro Tipo do documento: Dissertação 2025-06-24T00:00:00Z http://www.bdtd.uerj.br/handle/1/26182 Título: Avaliação do gradiente obstrutivo pelo ecocardiograma induzido pelo esforço em cicloergômetro nos pacientes portadores de cardiomiopatia hipertrófica correlacionando com os critérios de morte súbita Autor: Rocha, Júlia Paulo Mourilhe Primeiro orientador: Rocha, Ricardo Mourilhe Abstract: Hypertrophic cardiomyopathy (HCM) is a genetic condition characterized by left ventricular (LV) hypertrophy and heterogeneous clinical manifestations, with sudden cardiac death (SCD) being one of its most feared complications. Objectives: The primary objective of this study is to compare patients with obstructive and non-obstructive HCM during physical exertion in terms of the presence of SCD risk markers. Secondary objectives include comparing clinical, echocardiographic, and cycle ergometer variables associated with cardiac magnetic resonance (MRI) markers of SCD risk, as well as comparing the variation in left ventricular outflow tract (LVOT) gradient during Valsalva and exercise, and correlating these with MRI findings and the HCM Risk-SCD Score. Methodology: This is a cross-sectional, observational study involving a convenience sample of 38 patients with HCM and an LVOT gradient < 50 mmHg on resting echocardiography. Patients underwent exercise echocardiography on a cycle ergometer, with analysis of clinical, functional, echocardiographic, Holter, and cardiac MRI parameters. Results: The mean age of participants was 49 years, with 65.8% being male. Among the 38 patients, 23.3% presented with non-sustained ventricular tachycardia (NSVT), 11.5% had fibrosis > 15% on MRI, and 18.4% had an implantable cardioverter-defibrillator (ICD). Approximately 23% of patients developed significant obstruction during exertion. However, there was no statistical difference between the obstructive and non-obstructive groups during exertion regarding SCD risk markers such as NSVT, extensive fibrosis, septal thickness > 30 mm, or ESC HCM Risk-SCD Score > 6%. Left ventricular ejection fraction (LVEF) was lower in the group with myocardial fibrosis (66% vs. 77%, p=0.02), and longitudinal strain was reduced in patients with fibrosis ≥ 15% (8% vs. 14.6%, p=0.01), suggesting relevant functional impact. Multiple linear regression analysis identified maximum LV wall thickness as the variable most strongly associated with the European risk score, while the LVOT gradient during exertion showed no significant association. Conclusion: It is concluded that the presence of dynamic obstruction during exertion, although functionally relevant, did not correlate with SCD risk markers. Conversely, parameters such as septal thickness, LVEF, and extensive fibrosis on MRI demonstrated greater prognostic value. These findings highlight the need for a multimodal approach in risk stratification for HCM, emphasizing the combined use of resting echocardiography with functional parameters such as strain, stress echocardiography, peak oxygen consumption (VO₂), cardiac MRI, and genetic testing to ensure an individualized and accurate assessment of SCD risk in HCM. Instituição: Universidade do Estado do Rio de Janeiro Tipo do documento: Dissertação 2025-07-28T00:00:00Z