Thales Allyrio Araújo de Medeiros Fernandes

Introduction: Type 1 Diabetes Mellitus (T1DM) is a multifactorial autoimmune disease marked by pancreatic β-cell destruction and insulin deficiency. Its pathogenesis involves genetic predisposition, environmental exposures, and epigenetic modifications. This review examines how epigenetic mechanisms, including DNA methylation, histone modifications, and noncoding RNAs, contribute to T1DM and their potential as biomarkers and therapeutic targets. Methods: A comprehensive literature review was conducted using PubMed, Scopus, Web of Knowledge, and Google Scholar. Studies on DNA methylation, histone modifications, and noncoding RNA expression in T1DM patients and experimental models were analyzed to identify mechanisms linking epigenetic mechanisms to disease progression. Results: Epigenetic alterations, including abnormal DNA methylation, histone modifications, and dysregulated non-coding RNAs, play central roles in immune imbalance and β-cell dysfunction. DNA methylation affects genes involved in immune regulation, insulin synthesis, and β-cell survival. Non-coding RNAs regulate transcriptional and inflammatory pathways, while histone modifications alter chromatin accessibility, further contributing to β-cell loss. Discussion: Epigenetic mechanisms mediate interactions between genetic risk and environmental triggers, shaping autoimmunity and disease heterogeneity. These findings underscore their relevance for early detection and targeted interventions in T1DM. Conclusion: Epigenetic changes form a critical link between genetics, environment, and immune dysfunction in T1DM. By regulating immune responses and β-cell integrity, they drive disease onset and progression. Their study provides opportunities for predictive biomarkers and innovative therapies aimed at reprogramming epigenetic pathways to restore immune tolerance and preserve β-cell function.

Este artigo buscou analisar a prevalência de distress em pacientes em tratamento inicial radioterápico através do Termômetro de Distress. Trata-se de um estudo transversal, quantitativo e descritivo realizado com 88 pacientes atendidos no ano de 2021. Para coleta dos dados utilizou-se um formulário sociodemográfico e o Termômetro de Distress. Foi realizada uma análise descritiva e análise bivariada através do Teste qui-quadrado. Houve predominância do sexo feminino, idosos(as), com baixo nível de escolaridade e diagnóstico de câncer de mama. A maioria dos(as) pacientes reportaram valores moderado a grave de distress e alta prevalência de sintomas emocionais. Sendo assim, constatou-se elevados valores de Termômetro de Distress, acarretando repercussão psicológica negativa em indivíduos com diagnóstico de câncer e terapêutica inicial de radioterapia. Com isso, propõe-se a implantação do Termômetro de Distress nas rotinas das instituições oncológicas como um meio de identificação e prevenção de distúrbios de saúde mental.

Introduction: Immunotherapy has emerged as a major therapeutic strategy for cancer, and accumulating evidence indicates that the gut microbiota influences its effectiveness, highlighting the potential role of dietary fiber. Objective: To evaluate the scientific evidence regarding the relationship between dietary fiber intake, immune modulation, and the response to immunotherapy in patients with cancer. Methodology: An integrative review was conducted using the MEDLINE, BVS, and EMBASE databases with the descriptors “Neoplasms,” “Dietary Fiber,” and “Immunomodulation.” Original studies involving patients with cancer undergoing immunotherapy that evaluated dietary fiber intake through habitual diet, dietary intervention, or supplementation, as well as its association with immune response, gut microbiota, or clinical outcomes were included. Results: A total of 325 records were identified, of which three studies met the inclusion criteria. Discussion: Higher dietary fiber intake was associated with improved therapeutic responses and favorable changes in the gut microbiota. The included studies involved patients with melanoma receiving immune checkpoint inhibitors, predominantly anti‐PD‐1 therapy. Conclusion: Dietary fiber plays a relevant role in gut microbiota modulation and may enhance the effectiveness of immunotherapy.

Purpose: This systematic review aimed to identify risk factors related to decreased cardiac output in adults, thereby supporting the theoretical-causal validation of the nursing diagnosis Risk for Decreased Cardiac Output. Methods: A systematic review of etiology and risk was conducted in accordance with recognized guidelines, including meta-analysis of studies published between 1987 and 2024. Observational studies involving adult and older adult populations were selected from major electronic databases. Data extraction and quality appraisal were independently performed by multiple reviewers. Effect measures were synthesized using a random-effects model, with heterogeneity assessed across studies. Findings: Sixty-three studies were included, the majority with cohort designs. Key risk factors identified for decreased cardiac output were lower body surface area and lower body weight, with advanced age and female sex recognized as significant risk population characteristics. Associated conditions contributing to elevated risk included a history of stroke, shock, emergency cardiac surgery, diabetes, renal and pulmonary diseases, lower ejection fraction, and heart failure. Methodological variability in cardiac output measurement and significant heterogeneity among studies were notable challenges. Conclusions: Several significant risk factors for decreased cardiac output were identified and classified, providing scientific support for the theoretical-causal validation process of this nursing diagnosis. Addressing study heterogeneity and standardizing measurement methods are recommended for future research. Implications for Nursing Practice: The findings reinforce the clinical relevance of the nursing diagnosis Risk for Decreased Cardiac Output and highlight the need for tailored interventions by nursing professionals to prevent complications among at-risk cardiovascular patients.

Chagas disease remains a significant public health challenge in various endemic regions of Latin America. The persistence of vector‐borne transmission highlights the complexity of the issue and the limitations of traditional strategies. In this context, entomological surveillance plays a strategic and multifaceted role, not only in the early detection of triatomine bugs but also in guiding control actions tailored to territorial realities. This study aimed to analyse the contributions of entomological surveillance to the control of Chagas disease in endemic regions, considering the integration of traditional approaches, technological innovations, and participatory strategies. An integrative literature review was conducted based on the guiding question: ‘How does entomological surveillance contribute to the control of Chagas disease in different endemic regions?’ This study is an integrative review conducted in the PubMed, EMBASE, BVS and Web of Science databases, with no time restriction, including primary studies in Portuguese, English and Spanish. A total of 484 studies were identified. After screening and application of the eligibility criteria, 79 articles comprised the final sample, which were analysed through thematic categorisation and descriptive synthesis of the findings. Publications in Portuguese, English, and Spanish, with no time restrictions, were classified into six thematic categories: entomological indices and spatial mapping; factors associated with household invasion; vector control strategies; surveillance methods; professionals' perceptions; and challenges to the sustainability of actions. The findings revealed that entomological surveillance significantly contributes to the control of Chagas disease, especially when it integrates classical indicators, technological tools, and community‐based strategies. The role of entomological indices, interventions in peridomestic ecotopes, and the training of field agents stands out as essential pillars for the effectiveness of interventions. However, vector resistance to insecticides remains a critical obstacle, reinforcing the need for multisectoral, localised and sustainable actions.

Temporomandibular disorder (TMD) is a common musculoskeletal condition often associated with pain and functional limitation. Hyaluronic acid (HA) has been proposed as a minimally invasive therapeutic alternative for managing these dysfunctions due to its viscoelastic and anti-inflammatory properties. This integrative review aimed to compare the effectiveness of low- and high-molecular-weight sodium hyaluronate in the long-term improvement of pain symptoms in patients with TMD. A comprehensive search was performed in the PubMed, EMBASE, Cochrane, and BVS databases, without time restriction, resulting in the inclusion of seven studies that met the eligibility criteria. The findings indicated that both low- and high-molecular-weight HA effectively reduce pain and improve mandibular function. Low-molecular-weight HA showed faster regenerative effects, while high-molecular-weight HA demonstrated more prolonged anti-inflammatory action. However, most studies did not reveal statistically significant differences between formulations, suggesting comparable clinical efficacy. Despite methodological limitations and the limited number of long-term clinical trials, HA is considered a safe and effective therapeutic option for treating TMD. Further well-designed studies are needed to clarify the potential superiority between different molecular weights.

Introduction: Prejudice is a social phenomenon that, when manifested in different contexts, can negatively impact medical education by affecting students’ academic experiences and the quality of healthcare delivery. Objective: To analyze the perception of medical students from public and private institutions in Rio Grande do Norte (RN), Brazil, regarding experiences and situations of prejudice during medical training. Method: This is a descriptive, exploratory study with a quantitative approach, conducted with 588 students from four higher education institutions. Data collection was carried out through a structured questionnaire administered via Google Forms, encompassing sociodemographic information and experiences of prejudice. Data were analyzed using descriptive statistics and bivariate analysis through Pearson’s Chi-square test, with a 5% significance level. Results: The results indicated that 50.9% of participants observed episodes of prejudice in the academic environment, and 16.8% reported being direct victims. A significant association was found between the experience of prejudice and variables such as sexual orientation (p<0.001), age over 26 years (p<0.001), and marital status (married/stable union) (p<0.001). The most frequently reported types of prejudice were related to sexual orientation, gender, and ageism. It was concluded that prejudice is significantly present in medical education among the analyzed population, leading to the normalization of discriminatory practices in the academic environment. LGBTQIAPN+ students, older students, and those who were married or in a stable union reported higher experiences of prejudice in medical education. Conclusion: These findings highlight the need for consistent institutional strategies, including the transversal and continuous inclusion of diversity-related topics throughout medical training, the ongoing qualification of faculty members, and the implementation of mechanisms for support and confrontation. Such actions aim to promote more inclusive, humanized, and socially just medical education.

RESUMO Introdução: O preconceito é um fenômeno social que, ao se manifestar em diferentes contextos, pode impactar negativamente a formação médica, afetando a experiência acadêmica dos estudantes e a qualidade do atendimento em saúde. Objetivo: Este estudo teve como objetivo analisar a percepção dos discentes dos cursos de Medicina públicos e privados do Rio Grande do Norte (RN) acerca das vivências e situações de preconceito durante a formação médica. Método: Trata-se de um estudo descritivo, exploratório e de abordagem quantitativa, realizado com 588 estudantes de quatro instituições de ensino superior. A coleta de dados ocorreu por meio de questionário estruturado, aplicado via Google Forms, contemplando informações sociodemográficas e vivências de preconceito. Para a avaliação dos dados, utilizaram-se a estatística descritiva e a análise bivariada, por meio do teste qui-quadrado de Pearson, com nível de significância de 5%. Resultado: Os resultados indicaram que 50,9% dos participantes observaram episódios de preconceito no ambiente acadêmico e 16,8% relataram ter sido vítimas diretas. Houve associação significativa entre a vivência do preconceito e variáveis como orientação sexual (p < 0,001), idade superior a 26 anos (p < 0,001) e estado civil casado/união estável (p < 0,001). Entre os tipos de preconceito mais mencionados, destacaram-se orientação sexual, preconceito de gênero e etarismo. Conclui-se que o preconceito está presente de forma significativa na formação médica entre a população analisada, naturalizando práticas discriminatórias no ambiente acadêmico. Estudantes LGBTQIAPN+, mais velhos e casados/união estável relataram maior vivência de preconceito na educação médica. Conclusão: Esses achados evidenciam a necessidade de estratégias institucionais consistentes, incluindo a abordagem transversal e contínua de temas relacionados à diversidade ao longo da formação médica, a capacitação permanente do corpo docente e a implementação de mecanismos de enfrentamento e apoio. Tais ações visam promover uma educação médica mais inclusiva, humanizada e socialmente justa.

Hepatitis C virus (HCV) infection remains a major global health challenge and often progresses to chronic liver disease and hepatocellular carcinoma (HCC). Growing evidence indicates that epigenetic regulation mediated by non-coding RNAs plays a critical role in viral pathogenesis and tumor development. This review provides an integrated overview of the functions of microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs) in HCV-induced liver injury. We highlight the dual roles of these molecules, demonstrating how some ncRNAs promote viral replication, whereas others act as tumor suppressors that become dysregulated during infection. Particular emphasis is placed on interaction networks in which lncRNAs and circRNAs function as molecular sponges for miRNAs, thereby modulating signaling pathways essential for hepatic homeostasis. Disruption of these networks contributes to a pro-inflammatory and pro-tumorigenic microenvironment. Finally, we discuss the potential of these transcripts as diagnostic biomarkers and as emerging therapeutic targets in HCV-associated HCC.

Objetivo: Evidenciar os programas de Extensão Universitária como ferramenta para a formação de competências, habilidades médicas, bem como discutir oportunidades, desafios e possibilidades vivenciados na trajetória como extensionista. Métodos: Estudo exploratório e retrospectivo realizado mediante análise documental e sistematização de experiência vivenciada por discente do curso de Medicina enquanto bolsista de programa de Extensão na Universidade do Estado do Rio Grande do Norte. Resultados: A análise categorial revelou que as atividades recaíram em uma ou mais das três dimensões de competências determinadas pelas Diretrizes Curriculares Nacionais: Atenção, Gestão e Educação em Saúde. A Extensão permite desenvolver abordagens complexas, integrando a rede de Ensino, Saúde, Gestão e a comunidade. No panorama das transformações educacionais, a curricularização da Extensão soma uma peça chave para o fortalecimento desse processo. Conclusão: O processo de construção do conhecimento, na dimensão da Extensão, não deve ser tido como complementar ou acessório, mas trabalhado de forma permanente.