http://bibliotecatede.uninove.br/handle/tede/31 2026-06-02T17:48:57Z http://bibliotecatede.uninove.br/handle/tede/3983 Título: Impacto da fotobiomodulação com dispositivo de led de uso domiciliar na reabilitação de fraturas de úmero proximal: estudo clínico controlado randomizado duplo cego Autor: Freitas, Luiz Cláudio de Primeiro orientador: Ferrari, Raquel Agnelli Mesquita Abstract: Pain and joint stiffness are frequent complications after proximal humerus fractures (PHF), resulting in important functional limitation. Photobiomodulation (PBM) has shown benefits in fracture rehabilitation. This double-blind, randomized clinical trial evaluated the effects of PBM on the functional recovery of surgically treated PHF. Forty-two participants were randomized (1:1) into a Control group (physiotherapy + simulated PBM) and a PBM group (physiotherapy + active PBM). PBM was applied daily at home for 10 minutes using a device with 318 LEDs (159 LEDs at 660 nm: 28.5 mW, 12 J/cm², 17 J; and 159 LEDs at 850 nm: 23 mW, 10 J/cm², 14 J). PBM and physiotherapy sessions were conducted for 12 weeks. Participants and evaluators remained blinded to allocation, and assessments occurred at 24 h, 1, 2, 4, 8, and 12 weeks after surgery and daily through telephone contact. The primary outcome was shoulder function (QuickDASH). Secondary outcomes included range of motion, muscle strength, pain, analgesic consumption, quality of life (SF-6D), bone consolidation, occurrence of adverse events, and cost-effectiveness. Disability (QuickDASH) decreased over time in both groups, with a more pronounced reduction in the PBM group, although without significant interaction. There were no differences between groups in the evolution of range of motion, except for medial rotation, which showed lower values in the PBM group when comparing weeks 2, 8, and 12 versus day 1, without significant interaction. The PBM group showed fewer days with pain at weeks 8 and 12, with significant group–time interaction. Functional pain intensity showed significant interaction at weeks 4, 8, and 12, with lower intensity in the PBM group at week 12. For nighttime pain, there was significant interaction at week 12, with reduction in the PBM group and increase in the control. Both groups presented a progressive increase in pressure tolerated until the sensation of pain, without differences or significant interaction. Dipyrone consumption (days and tablets) showed significant interaction at weeks 8 and 12, with an increase in the control and lower values in the PBM group; this group also showed a lower mean number of days of dipyrone use. Tramadol use showed no differences or significant interactions. The SF-6D showed significant interactions at weeks 8 and 12, with a trend toward improvement in the PBM group. No differences were observed between groups in bone consolidation or muscle strength, and no adverse events related to PBM were reported. In the cost-effectiveness analysis, PBM demonstrated greater mean effectiveness in reducing QuickDASH scores and days with pain, although associated with incremental cost. PBM proved to be safe and associated with improvements in important clinical parameters, especially in reducing pain and dipyrone consumption between weeks 8 and 12, in addition to a trend toward improved quality of life. Although it did not alter global function, range of motion, muscle strength, or bone consolidation and generated financial increment, its analgesic effects suggest usefulness as an adjuvant to physiotherapy in the postoperative recovery of surgically treated PHF, indicating that PBM incorporation should simultaneously consider clinical gain and cost. Instituição: Universidade Nove de Julho Tipo do documento: Tese 2025-12-03T00:00:00Z http://bibliotecatede.uninove.br/handle/tede/3967 Título: Longo Covid-19: avaliação e comparação da qualidade de vida, sarcopenia e proteinúria em pacientes que tiveram apresentação clínica leve e moderada Autor: Montenegro, Sayane Marlla Silva Leite Primeiro orientador: Dalboni, Maria Aparecida Abstract: The pandemic caused by the coronavirus (SARS-CoV-2) called COVID-19, was responsible for high hospitalization and mortality rates. Patients recovered from COVID-19 (long COVID-19), especially those who were admitted to the ICU, report tiredness, dyspnea, muscle pain; which are associated with worse quality of life. However, there are few reports evaluating long COVID-19 in its sequelae regarding quality of life, sarcopenia and proteinuria in individuals with mild and moderate clinical presentation. Objective: To evaluate and compare quality of life, sarcopenia and proteinuria in patients with long COVID-19 according to mild and moderate clinical presentation. Methods: Quantitative and longitudinal study. We evaluated 253 individuals with mild (n=119) and moderate (n=134) clinical presentation for COVID-19 (positive RT-PCR) after 6 (T6) and 12 (T12) months from the date of acute infection. Quality of life was assessed using the Short Form 36 (SF – 36) questionnaire, pain using the visual analogue scale (VAS), risk of sarcopenia using the Simple Questionnaire to Rapidly Diagnose Sarcopenia (SARC-F), functionality using the Dominant Palm Grip Strength (HGS), Sit – Up (sit and stand), and with the aid of the Duke Activity Status Index Questionnaire (DASI) and proteinuria using a urinalysis strip. Results: The average age was 44±10 and 43±12 years; female 68% and 59% for the mild and moderate groups, respectively. 75% or more of patients were vaccinated with at least 2 doses before acquiring COVID-19 infection. Individuals with a moderate clinical presentation in relation to mild cases were: hypertensive (23% and 6%, p < 0.001) and with diabetes mellitus (9% and 2%; p = 0.01) at the time of COVID-19 infection. The moderate group showed a statistically significant difference at T6: lower functional capacity (SF36: 46±20 vs. 61±24); more pain (SF36: 45±29 vs. 67±32 and VAS: 55% vs. 32%); greater dysfunctionality for daily activities (DASI: 40±11 vs. 45±10); lower number of repetitions for lower limb muscle strength (Sit-up: 9±2 vs. 11±2); higher sarcopenia score (SARC-F: 6±4 vs. 4±3) and higher proteinuria ≥1”+”: 59% vs. 42%) compared to the mild group. After 12 months, the moderate group remained with greater pain (SF36+VAS) and more dysfunctionality in daily activities (DASI) compared to the mild group. Comparing T12 to T6, we observed that the mild group had worse functional capacity; more pain (SF36+VAS); lower FPP and higher proteinuria ≥1”+”: 63% vs. 42%). The moderate group had lower HGS; greater 10 number of repetitions for the Sit-up at T12 compared to T6. We observed that individuals who had a higher SARC-F score showed a negative correlation with upper limb strength (Handgrip/FPP); lower limbs (Sit-up); functional capacity (SF36); dysfunction for daily activities (DASI). Conclusion: our results show that individuals who had mild and moderate presentation at the time of COVID-19 infection had long-term COVID-19 sequelae. However, the moderate group had greater pain sequelae at T6 and T12 and a greater risk of sarcopenia after 6 months, reduced muscle strength, which may contribute to a worse quality of life for these individuals. Furthermore, the presence of proteinuria for both groups is a warning to evaluate renal function; through other biomarkers to determine whether this proteinuria is transient or whether the infection caused by SARS-CoV-2 may be a risk factor for loss of kidney function and progression of kidney disease. Therefore, it is necessary to develop strategies for physical rehabilitation and follow-up assessment of renal filtration function in this population. Instituição: Universidade Nove de Julho Tipo do documento: Tese 2023-12-14T00:00:00Z http://bibliotecatede.uninove.br/handle/tede/3966 Título: Efeitos do treinamento em ergômetro de braço na pressão arterial ambulatorial em pacientes com doença arterial periférica Autor: Costa, Renan Massena Primeiro orientador: Correia, Marilia de Almeida Abstract: Patients with peripheral artery disease (PAD) are at high risk of fatal and non-fatal cardiovascular events. Strategies that help reduce cardiovascular risk in these patients are necessary to improve the health and quality of life of these patients. Studies with arm crank (AC) training have shown benefits in the functional capacity of patients with PAD, bypassing the main barrier to exercising in these patients, pain. However, the effect of this type of training on indicators of cardiovascular function, such as ambulatory blood pressure, is not yet established. Therefore, the aim of the present study was to analyze the effects of AC training on ambulatory blood pressure in patients with PAD and to compare it with the current exercise recommendation, walking training (WT). In this randomized controlled clinical trial, patients were randomly allocated into three experimental groups: AC training, WT and control group (CG). The AC and WT groups performed two weekly sessions with an intensity equivalent to 13-15 on the Borg subjective perception of exertion scale. Patients in the CG attended twice a week just to carry out various activities and socializing in a group, with no exercise involved. In addition, all groups were encouraged to increase their level of physical activity, which is usually the guideline in clinical management. Prior to the start and after 12 weeks of intervention, the following indicators of ambulatory blood pressure systolic (SBP), mean (MAP) and diastolic (DBP) were obtained: 24-hour mean, waking period, sleeping period, morning rise, nocturnal pressure load and mean real variability. For the analysis, the generalized estimation equations were used, having as factors the groups (AC, WT and CG) and the times (pre and post-intervention) and P <0.05 as significance. All groups started from the same ambulatory blood pressure values. After 12 weeks, it was possible to observe an interaction effect on the 24-hour DBP with a post hoc effect only on the AC [pre 78 (10) vs. powder 72 (5) mmHg, p=0.005]; in the MAP of wakefulness in [AC: pre 94 (11) vs. post 96 (11), p=0.044] and [WT: pre 94 (11) vs. post 96 (11) mmHg, p=0.044]; in wakefulness DBP of the AC group [pre 81 (11) vs. powder 76 (14) mmHg, p=0.001]; in the 24-hour DBP pressure load [AC: pre 45 (42) vs. powder 24 (35) %, p=0.016]; in the real mean variability of DBP [AC: pre 9 (3) vs. powder 8 (2); and WT pre 7 (3) vs. after 8 (3), CG: pre 7 (4) vs. after 7 (3), p=0.018. In the other variables, it was not possible to observe significant effects. In conclusion, the preliminary results of this clinical trial demonstrate that 12 weeks of AC training possibly reduces 24h DBP and waking DBP and MAP, DBP values in real mean variability and 24h pressure load in patients with PAD and symptoms of intermittent claudication. Instituição: Universidade Nove de Julho Tipo do documento: Dissertação 2023-06-13T00:00:00Z http://bibliotecatede.uninove.br/handle/tede/3965 Título: Estudo dos hormônios tireoidianos em uma unidade de terapia intensiva obstétrica Autor: Motta, Míriam Duarte de Arruda Primeiro orientador: Camacho, Cleber Pinto Abstract: Physiological changes in thyroid function during pregnancy are important for maintaining homeostasis. It is estimated that hypothyroidism occurs in 4% of pregnancies (0.5% true hypothyroidism and 3.5% subclinical hypothyroidism) and hyperthyroidism occurs in 2.4% of pregnancies (0.6% true hyperthyroidism and 1 .8% subclinical hyperthyroidism). Because thyroid hormones have many effects on cardiovascular and renal physiology, thyroid dysfunction can have a significant impact on critically ill patients in the Intensive Care Unit (ICU). Our objective is to evaluate the degree of association between hormonal concentrations and clinical repercussions (age, weight, BMI, gestational age, complications and death) in critically ill pregnant women, according to the severity criteria of the APACHE II Prognostic and Mortality Score and compare the different reference methods of values of thyroid hormones (THs) in the diagnosis of thyroid dysfunctions, such as hypothyroidism, hyperthyroidism and sick euthyroid syndrome in pregnant women admitted to the ICU. Materials and methods: 1425 pregnant women admitted to the ICU, from January 2018 to December 2022, were evaluated and 160 pregnant women with thyroid hormones measured at admission were included. The study is retrospective, therefore, we used data from medical records of women with clinical diseases during the period of admission to the ICU, such as sepsis, diabetes mellitus, cardiovascular disorders, bleeding disorders, hydroeletrolytic disorders, obstetric infection, SARS CoV-2 infection, respiratory disorders, pregnant women with eclampsia and severe pre-eclampsia (PE). The women were divided into groups according to TSH and free T4 values, according to the values of the established laboratory test, and evaluated using the Hoffman mathematical method compared with the prognostic scores used in ICUs and their complications. Based on the results obtained, all the complications were significant in Q-square test. The hemodynamic instability, respiratory failure, uterine hemorrhage, fetal death and psychological disorders were significant in many Analysis. The conclusion was na evidente association between thyroid hormones and BMI, gestational age through Ultrasound and some complications observed in the obstetric ICU, as respiratory failure, hemodynamic instability uterine hemorrhage and fetal death, ix suggest that hormonal dosage can be used as a predictor of complications in obstetric therapy. Instituição: Universidade Nove de Julho Tipo do documento: Tese 2023-12-15T00:00:00Z