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Enfermedad de Paget pigmentada de la mama simuladora de melanoma cutáneo
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Cano-Aguilar, Luis Enrique

; Villamil-Cerda, Dante

; Monroy-Prado, Gisela Abigail

; Vega-Memije, María Elisa

; Sáenz-Corral, Claudia Ileana

Ginecología y obstetricia de México

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2023, Volume 91 N. 1 Pages 39 - 43

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

Resumen ANTECEDENTES: La enfermedad de Paget pigmentada de la mama es una variante poco frecuente de este padecimiento cutáneo, una dermatosis que afecta al complejo areola-pezón de manera típicamente unilateral. La importancia del reconocimiento de esta dermatosis pigmentada inespecífica es que forma parte del diagnóstico diferencial del melanoma cutáneo, por manifestarse como una mácula pigmentada irregular, cuyo estudio histopatológico muestra una proliferación de melanocitos en los estratos suprabasales de la epidermis, fagocitosis de melanina y melanófagos en dermis, hallazgos muy similares al melanoma cutáneo, además de la coexistencia de células claras malignas, características de la enfermedad de Paget. La inmunohistoquímica es una técnica auxiliar en la dermatopatología, que forma parte del proceso diagnóstico de los pacientes para lograr el diagnóstico certero que, al correlacionar la clínica y el estudio histopatológico, le permite al dermatólogo tratar a los pacientes con enfermedad de Paget pigmentada de la mama junto con un equipo multidisciplinario para la búsqueda, diagnóstico y, en su caso, tratamiento quirúrgico de las neoplasias subyacentes que suelen relacionarse con esta variante pigmentada. CASO CLÍNICO: Paciente de 35 años con una lesión pigmentada que afectaba el complejo areola-pezón derecho. Con la correlación histopatológica e inmunohistoquímica se estableció el diagnóstico de enfermedad de Paget pigmentada de la mama y posterior al procedimiento ginecológico, se asoció esta dermatosis con un adenocarcinoma microinvasor triple negativo. CONCLUSIONES: La enfermedad de Paget pigmentada de la mama es un diagnóstico complejo que requiere correlación clínico-patológica y estudios de extensión para valorar su asociación con neoplasias subyacentes.

Abstract BACKGROUND: Pigmented Mammary Paget’s Disease is a rare variant of this skin condition, an unilateral dermatosis that typically affects the areola-nipple complex. The importance of recognizing this nonspecific pigmented dermatosis resides in its differential diagnosis of cutaneous melanoma, as it presents as an irregular pigmented macula. The histopathological study shows proliferation of melanocytes in the suprabasal layers of epidermis, phagocytosis of melanin and melanophages in dermis. These findings are very similar to cutaneous melanoma, in addition to the presence of malignant clear epitelial cells that are characteristic of Paget’s disease. Immunohistochemistry is part of the approach of patients with lesions that shows proliferating melanocytes to rule out other neoplasms. Making an accurate diagnosis by correlating the clinical, histopathological study and immunohistochemistry allows the dermatologist to approach patients with mammary pigmented mammary Paget’s disease with a multidisciplinary team for the diagnosis and surgical treatment of the underlying neoplasms that are usually related to this pigmented variant. CASE REPORT: We report the case of a 35 years old woman with a pigmented lesion that affected the right areola-nipple complex. With the histopathological and immunohistochemical correlation, the diagnosis of pigmented mammary Paget’s disease was made and after the gynecological approach, this dermatosis was associated with a triple negative microinvasive adenocarcinoma. CONCLUSION: Pigmented mammary Paget’s disease is a complicated diagnosis that requires clinicopathological correlation and extension studies to assess its association to underlying neoplasms.

https://doi.org/10.24245/gom.v91i1.7305

Consensus on the therapeutic management of atopic dermatitis ‒ Brazilian Society of Dermatology: an update on phototherapy and systemic therapy using e-Delphi technique
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Orfali, Raquel Leao

; Lorenzini, Daniel

; Bressan, Aline

; Tanaka, Anber Ancel

; Cerqueira, Ana Maria Mósca de

; Hirayama, André da Silva

; Ramos, Andréa Machado Coelho

; Proença, Carolina Contin

; Silva, Claudia Marcia de Resende

; Laczynski, Cristina Marta Maria

; Carneiro, Francisca Regina

; Duarte, Gleison

; Hans Filho, Gunter

; Gonçalves, Heitor de Sá

; Melo, Ligia Pessoa de

; Azulay-Abulafia, Luna

; Weber, Magda Blessmann

; Rivitti-Machado, Maria Cecília

; Zaniboni, Mariana Colombini

; Ogawa, Marília

; Pires, Mario Cezar

; Ianhez, Mayra

; Felix, Paulo Antonio Oldani

; Bonamigo, Renan

; Takaoka, Roberto

; Lazzarini, Rosana

; Cestari, Silmara

; Mayor, Silvia Assumpção Soutto

; Cestari, Tania

; Oliveira, Zilda Najjar Prado de

; Spuls, Phyllis I.

; Gerbens, Louise A.A.

; Aoki, Valeria

Anais Brasileiros de Dermatologia

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2023, Volume 98 N. 6 Pages 814 - 836

Abstract: En | Text: En | PDF: En

Abstract This publication is an update of the “Consensus on the therapeutic management of atopic dermatitis - Brazilian Society of Dermatology” published in 2019, considering the novel, targeted-oriented systemic therapies for atopic dermatitis. The initial recommendations of the current consensus for systemic treatment of patients with atopic dermatitis were based on a recent review of scientific published data and a consensus was reached after voting. The Brazilian Society of Dermatology invited 31 experts from all regions of Brazil and 2 international experts on atopic dermatitis who fully contributed to the process. The methods included an e-Delphi study to avoid bias, a literature search and a final consensus meeting. The authors added novel approved drugs in Brazil and the indication for phototherapy and systemic therapy for AD. The therapeutical response to systemic treatment is hereby reported in a suitable form for clinical practice and is also part of this updated manuscript.

https://doi.org/10.1016/j.abd.2023.04.003

Prevalence of self-medication and associated factors in adolescents aged 18-19 years: the 1997/1998 cohort in São Luís-MA, Brazil
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Godinho, Joseane Lima Prado

; Magalhães, Elma Izze da Silva

; Santos, Alcione Miranda dos

; Pinho, Judith Rafaelle Oliveira

; Chagas, Deysianne Costa das

; Ribeiro, Cecília Cláudia Costa

; Britto, Maria Helena Seabra Soares de

; Alves, Maria Teresa Seabra Soares de Britto e

Ciência & Saúde Coletiva

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aug 2022, Volume 27 N. 8 Pages 3341 - 3353

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

Abstract This article aims to assess the prevalence and factors associated with self-medication in adolescents. Cross-sectional study, nested in cohort, with 2,515 adolescents aged 18-19 years born in São Luís-MA. The use of medication in the last 15 days without a medical prescription or by a qualified professional was considered self-medication. Factors associated with self-medication were evaluated using Poisson regression with robust variances and hierarchical selection of variables. Medicines were used in the last 15 days by 48.05% of adolescents. Among these, 70.09% use it without a prescription or indication from another health professional. The most used medications for self-medication were “over the counter” (93.68%). Self-medication was positively associated with female gender (PR: 1.41; 95%CI: 1.25-1.59), screen time ≥5h/day (PR: 1.32; 95%CI: 1.05-1.67) and self-reported diagnosis of allergic rhinitis (PR: 1.19; 95%CI: 1.02-1.39); however, negatively associated with self-satisfaction with health (PR: 0.79; 95%CI: 0.67-0.94) and hospitalization in the previous year (PR: 0.70; 95%CI: 0.50-0.97). Self-medication was common among adolescents and to reduce this practice, greater attention should be given to women, individuals with intense exposure to meshes and allergic diseases.

Resumo O objetivo deste artigo é avaliar a prevalência e os fatores associados a automedicação em adolescentes. Estudo transversal, aninhado a uma coorte, com 2.515 adolescentes de 18-19 anos nascidos em São Luís-MA. O uso de algum medicamento nos últimos 15 dias sem prescrição médica ou de profissional habilitado foi considerado automedicação. Os fatores associados a automedicação foram avaliados usando regressão de Poisson com variâncias robustas e seleção hierárquica das variáveis. Medicamentos foram utilizados nos últimos 15 dias por 48,05% dos adolescentes. Entre estes, 70,09% fazem uso sem receita médica ou indicação de outro profissional de saúde. Os medicamentos mais utilizados na automedicação foram os “over the counter” (93,68%). A automedicação foi positivamente associada ao sexo feminino (RP: 1,41; IC95%: 1,25-1,59), tempo de tela ≥5h/dia (RP: 1,32; IC95%: 1,05-1,67) e diagnóstico autorreferido de rinite alérgica (RP: 1,19; IC95%: 1,02-1,39); porém, negativamente associada a autossatisfação com a saúde (PR: 0,79; IC95%: 0,67-0,94) e hospitalização no ano anterior (RP: 0,70; IC95%: 0,50-0,97). A automedicação foi comum entre os adolescentes e para redução dessa prática uma maior atenção deve ser dada a mulheres, indivíduos com intensa exposição a telas e doenças alérgicas.

https://doi.org/10.1590/1413-81232022278.22722021

Prevalence of self-medication and associated factors in adolescents aged 18-19 years: the 1997/1998 cohort in São Luís-MA, Brazil
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Godinho, Joseane Lima Prado

; Magalhães, Elma Izze da Silva

; Santos, Alcione Miranda dos

; Pinho, Judith Rafaelle Oliveira

; Chagas, Deysianne Costa das

; Ribeiro, Cecília Cláudia Costa

; Britto, Maria Helena Seabra Soares de

; Alves, Maria Teresa Seabra Soares de Britto e

Ciência & Saúde Coletiva

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aug 2022, Volume 27 N. 8 Pages 3341 - 3353

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/1413-81232022278.22722021

Evaluación de la torre despojadora T-201 del bloque de estabilización de la Refinería Cienfuegos S. A
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Aguila-Prado, Claudia

; Cortés-Martínez, Roxana

; Chou-Rodríguez, Elisa María

; Martinez-Olmo, Yanelain

Tecnología Química

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apr 2022, Volume 42 N. 1 Pages 56 - 69

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

ABSTRACT The stabilizing tower T-201 of the catalytic reforming plant of the Refinería Cienfuegos S.A. it should be able to strip moisture from the naphtha up to 5 ppm. According to the results of the Karl Fisher Coulometric Tritation method, there is a possibility that they do not satisfy the process requirements, which is why in this investigation the performance of the T-201 was evaluated. First, the laboratory results of the moisture content of the inlet and outlet of the tower were statistically analyzed to define the range of the values obtained and their reliability. The PRO/II 9.1 software was used to model the unit and then validated with actual operating parameters. With Matlab software, the sensitivity to the behavior of the temperature of the top of the tower with the variation of humidity in the inlet naphtha was analyzed. Laboratory results showed significant deviations so they are not reliable for measuring moisture content. The model obtained showed deviations below 5%, this being valid for the evaluation of the T-201 tower. In addition, the sensitivity analysis showed a logical behavior of the tower with the variation of temperature and humidity. Finally, that the method used for the analysis of humidity shows errors in its execution and therefore another method of analysis must be used. In addition, the model obtained from the tower can be used to evaluate other operating variables.

RESUMEN La torre estabilizadora T-201 de la planta de reformación catalítica de la Refinería Cienfuegos S.A. debe ser capaz de despojar la humedad de la nafta hasta 5 ppm. Según los resultados del método de Tritación Coulométrica Karl Fisher, existe la posibilidad de que no satisfagan los requerimientos de proceso por lo que en esta investigación se evaluó el funcionamiento de la T-201. Primeramente, se analizó estadísticamente los resultados de laboratorio del contenido de humedad de la entrada y salida de la torre para definir el rango de los valores obtenidos y su confiabilidad. Se utilizó el software PRO/II 9.1 para elaborar un modelo de la unidad y luego se validó con parámetros reales de operación. Con el software Matlab se analizó la sensibilidad al comportamiento de la temperatura del tope de la torre con la variación de humedad en la nafta de entrada. Los resultados del laboratorio mostraron desviaciones significativas por lo que no son confiables para medir el contenido de humedad. El modelo obtenido arrojó desviaciones por debajo del 5 %, siendo este válido para la evaluación de la torre T-201. Además el análisis de sensibilidad mostró un comportamiento lógico de la torre con la variación de la temperatura y la humedad. Finalmente, que el método empleado para el análisis de la humedad muestra errores en su ejecución y por tanto se debe utilizar otro método de análisis. Además, el modelo obtenido de la torre puede ser utilizado para evaluar otras variables de operación.

Occurrence of tick-borne pathogens in dogs in a coastal region of the state of Ceará, northeastern Brazil
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Fonsêca, Arícia Débora Vasconcelos

; Oliveira, Lorena Mayana Beserra de

; Jorge, Felipe Rodrigues

; Cavalcante, Ramuelly Olinda

; Bevilaqua, Claudia Maria Leal

; Pinto, Francisco José Maia

; Santos, Jessica Maria Leite dos

; Teixeira, Bruno Marques

; Rodrigues, Ana Kétylla Ponte Prado

; Braz, Gissandra Farias

; Viana, Geysa Almeida

; Costa, Edmara Chaves

; Serpa, Maria Carolina de Azevedo

; Weck, Bárbara Conte

; Labruna, Marcelo Bahia

Revista Brasileira de Parasitologia Veterinária

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2022, Volume 31 N. 1 elocation e021321

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo O objetivo deste estudo foi determinar a ocorrência de patógenos transmitidos por carrapatos (Ehrlichia canis, Babesia vogeli, Hepatozoon spp. e Rickettsia spp.) em cães na Vila de Jericoacoara, região costeira do Ceará, Brasil. Amostras de sangue foram coletadas de 153 animais e analisadas por métodos moleculares e sorológicos. Sessenta animais foram encontrados infectados ou expostos a pelo menos a um dos patógenos estudados. Babesia vogeli foi o patógeno mais prevalente (15%), seguido por E. canis (13,7%) e Hepatozoon spp. (11,8%), que foi identificado como Hepatozoon canis por sequenciamento. Vinte cães (13%) foram sororreativos à Rickettsia spp. Rhipicephalus sanguineus sensu lato foi observado em 11,8% dos animais. Houve associações entre idade (<3 anos) e positividade para B. vogeli, e entre habitação (cães de rua) e positividade para H. canis. Também houve associações entre anemia e infecção por H. canis, e entre leucopenia e exposição a Rickettsia spp. Não foi detectada associação entre alterações clínicas e infecção ou exposição aos patógenos estudados. Os resultados confirmaram que patógenos de importância veterinária estão circulando no nordeste do Brasil e mostraram que cães estão expostos a espécies de Rickettsia com potencial zoonótico, indicando a necessidade de medidas de controle do vetor.

Abstract The aim of this study was to determine the occurrence of tick-borne pathogens (Ehrlichia canis, Babesia vogeli, Hepatozoon spp. and Rickettsia spp.) in dogs in Vila de Jericoacoara, coastal region of Ceará, Brazil. Blood samples were collected from 153 animals and analyzed using molecular and serological methods. Sixty animals were found to be infected or exposed to at least one of the pathogens studied. Babesia vogeli was the most prevalent pathogen (15%), followed by E. canis (13.7%) and Hepatozoon spp. (11.8%), which was identified as Hepatozoon canis through sequencing. Twenty dogs (13%) were seroreactive to Rickettsia spp. Rhipicephalus sanguineus sensu lato was observed on 11.8% of the animals. There were associations between age (< 3 years old) and positivity for B. vogeli, and between habitation (stray dogs) and positivity for H. canis. There were also associations between anemia and infection with H. canis, and between leukopenia and exposure to Rickettsia spp. No association was detected between clinical alterations and infection with or exposure to the pathogens studied. The results confirmed that pathogens of veterinary importance are circulating in northeastern Brazil and showed that dogs are exposed to Rickettsia species with zoonotic potential, thus indicating a need for vector control measures.

https://doi.org/10.1590/s1984-29612022010

GAMES AS AN EDUCATIONAL TECHNOLOGY FOR THE INVOLVEMENT OF COMPANIONS IN PEDIATRIC PATIENT SAFETY: A QUALITATIVE STUDY
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Costa, Maria Tereza Teles Coelho Aguilar

; Morais, Karyne Maria de

; Cavanellas, Anna Cláudia Santos Prado

; Santos, Viviane Euzébia Pereira

; Corrêa, Allana dos Reis

; Manzo, Bruna Figueiredo

Texto & Contexto - Enfermagem

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2021, Volume 30 elocation e20200651

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

RESUMO Objetivo descrever o significado atribuído à utilização do lúdico como tecnologia educativa para o envolvimento de acompanhantes na segurança do paciente pediátrico. Método estudo qualitativo, realizado com 16 acompanhantes de crianças internadas na Unidade Pediátrica do hospital público de Minas Gerais, Brasil. A coleta de dados ocorreu de outubro a dezembro de 2019, por meio de entrevistas semiestruturadas, após utilização do jogo, como tecnologia educativa. Utilizou-se o Interacionismo Simbólico como referencial teórico, e a Análise de Conteúdo Indutiva como método. Resultados a realização do jogo em busca da segurança do paciente apresentou-se como uma importante estratégia de compartilhamento de conhecimento e corresponsabilização dos acompanhantes em se engajarem nas ações de segurança do paciente pediátrico, além da relevante contribuição na prevenção de eventos adversos. Por outro lado, a sobrecarga dos profissionais e os problemas de comunicação se destacaram como barreiras para o estabelecimento do vínculo entre a equipe de saúde e, consequentemente, engajamento dos acompanhantes na segurança do paciente. Conclusão os acompanhantes reconheceram-se como parceiros na prevenção de eventos adversos e destacaram algumas mudanças de comportamento em prol da segurança do paciente após participação na intervenção lúdica. Assim, considera-se que o jogo pode ser uma estratégia importante e interativa de divulgação de informação à acompanhantes e familiares e, consequentemente, favorecedora para o aumento da participação desses atores nas ações de segurança do paciente.

ABSTRACT Objective to describe the meaning attributed to the use of a game as an educational technology for the involvement of companions in pediatric patient safety. Method a qualitative study carried out with 16 companions of children admitted to the Pediatric Unit of the public hospital in Minas Gerais, Brazil. Data collection took place from October to December 2019, through semi-structured interviews, after using the game as an educational technology. Symbolic Interactionism was used as the theoretical framework and Inductive Content Analysis, as the method. Results playing the game in search of patient safety was an important strategy for sharing knowledge and co-responsibility for the companions to engage in the pediatric patient safety actions, in addition to a relevant contribution to the prevention of adverse events. On the other hand, the professionals' overload and communication problems stood out as barriers to the establishment of a bond among the health team members and, consequently, the involvement of the companions in patient safety. Conclusion the companions recognized themselves as partners in the prevention of adverse events and highlighted some behavioral changes in favor of patient safety after participating in the playful intervention. Thus, it is considered that the game can be an important and interactive strategy for disseminating information to companions and family members and, consequently, favoring the increased participation of these actors in patient safety actions.

RESUMEN Objetivo describir el significado que se atribuye a la utilización de lo lúdico como tecnología educativa para implicar a los acompañantes en la seguridad del paciente pediátrico. Método estudio cualitativo, realizado con 16 acompañantes de niños internados en la Unidad Pediátrica del hospital público de Minas Gerais, Brasil. La recolección de datos se llevó a cabo de octubre a diciembre de 2019, por medio de entrevistas semiestructuradas, después de haber utilizado el juego como tecnología educativa. Se utilizó el Interaccionismo Simbólico como marco teórico, y el Análisis de Contenido Inductivo como método. Resultados la realización del juego en busca de la seguridad del paciente se erigió como una estrategia importante para compartir conocimientos y fomentar la implicación de los acompañantes en acciones de seguridad del paciente pediátrico, además de representar una contribución relevante a la prevención de eventos adversos. Por otro lado, la sobrecarga de profesionales y los problemas de comunicación se destacaron como barreras para el establecimiento de un vínculo entre el equipo de salud y, en consecuencia, la implicación de los acompañantes en la seguridad del paciente. Conclusión los acompañantes se reconocen como pares en la prevención de eventos adversos y señalaron algunos cambios de comportamiento en beneficio de la seguridad del paciente después de participar en la intervención lúdica. Así, se considera que el juego puede ser una estrategia importante e interactiva para difundir información a los acompañantes y familiares y, en consecuencia, favorecer la mayor participación de estos actores en las acciones de seguridad del paciente.

https://doi.org/10.1590/1980-265x-tce-2020-0651 208 downloads

Persistent symptoms and decreased health-related quality of life after symptomatic pediatric COVID-19: A prospective study in a Latin American tertiary hospital
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Fink, Thais T.

; Marques, Heloisa H.S.

; Gualano, Bruno

; Lindoso, Livia

; Bain, Vera

; Astley, Camilla

; Martins, Fernanda

; Matheus, Denise

; Matsuo, Olivia M.

; Suguita, Priscila

; Trindade, Vitor

; Paula, Camila S.Y.

; Farhat, Sylvia C.L.

; Palmeira, Patricia

; Leal, Gabriela N.

; Suzuki, Lisa

; Odone Filho, Vicente

; Carneiro-Sampaio, Magda

; Duarte, Alberto José S.

; Antonangelo, Leila

; Batisttella, Linamara R.

; Polanczyk, Guilherme V.

; Pereira, Rosa Maria R.

; Carvalho, Carlos Roberto R.

; Buchpiguel, Carlos A.

; Latronico, Ana Claudia

; Seelaender, Marilia

; Silva, Clovis Artur

; Pereira, Maria Fernanda B.

; Sallum, Adriana M. E.

; Brentani, Alexandra V. M.

; Neto, Álvaro José S.

; Ihara, Amanda

; Santos, Andrea R.

; Canton, Ana Pinheiro M.

; Watanabe, Andreia

; Santos, Angélica C. dos

; Pastorino, Antonio C.

; Franco, Bernadette D. G. M.

; Caruzo, Bruna

; Ceneviva, Carina

; Martins, Carolina C. M. F.

; Prado, Danilo

; Abellan, Deipara M.

; Benatti, Fabiana B.

; Smaria, Fabiana

; Gonçalves, Fernanda T.

; Penteado, Fernando D.

; Castro, Gabriela S. F. de

; Gonçalves, Guilherme S.

; Roschel, Hamilton

; Disi, Ilana R.

; Marques, Isabela G.

; Castro, Inar A.

; Buscatti, Izabel M.

; Faiad, Jaline Z.

; Fiamoncini, Jarlei

; Rodrigues, Joaquim C.

; Carneiro, Jorge D. A.

; Paz, Jose A.

; Ferreira, Juliana C.

; Ferreira, Juliana C. O.

; Silva, Katia R.

; Bastos, Karina L. M.

; Kozu, Katia

; Cristofani, Lilian M.

; Souza, Lucas V. B.

; Campos, Lucia M. A.

; Silva Filho, Luiz Vicente R. F.

; Sapienza, Marcelo T.

; Lima, Marcos S.

; Garanito, Marlene P.

; Santos, Márcia F. A.

; Dorna, Mayra B.

; Aikawa, Nadia E.

; Litvinov, Nadia

; Sakita, Neusa K.

; Gaiolla, Paula V. V.

; Pasqualucci, Paula

; Toma, Ricardo K.

; Correa-Silva, Simone

; Sieczkowska, Sofia M.

; Imamura, Marta

; Forsait, Silvana

; Santos, Vera A.

; Zheng, Yingying

Clinics

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2021, Volume 76 elocation e3511

Abstract: En | Text: En | PDF: En

OBJECTIVES: To prospectively evaluate demographic, anthropometric and health-related quality of life (HRQoL) in pediatric patients with laboratory-confirmed coronavirus disease 2019 (COVID-19) METHODS: This was a longitudinal observational study of surviving pediatric post-COVID-19 patients (n=53) and pediatric subjects without laboratory-confirmed COVID-19 included as controls (n=52) was performed. RESULTS: The median duration between COVID-19 diagnosis (n=53) and follow-up was 4.4 months (0.8-10.7). Twenty-three of 53 (43%) patients reported at least one persistent symptom at the longitudinal follow-up visit and 12/53 (23%) had long COVID-19, with at least one symptom lasting for >12 weeks. The most frequently reported symptoms at the longitudinal follow-up visit were headache (19%), severe recurrent headache (9%), tiredness (9%), dyspnea (8%), and concentration difficulty (4%). At the longitudinal follow-up visit, the frequencies of anemia (11% versus 0%, p=0.030), lymphopenia (42% versus 18%, p=0.020), C-reactive protein level of >30 mg/L (35% versus 0%, p=0.0001), and D-dimer level of >1000 ng/mL (43% versus 6%, p=0.0004) significantly reduced compared with baseline values. Chest X-ray abnormalities (11% versus 2%, p=0.178) and cardiac alterations on echocardiogram (33% versus 22%, p=0.462) were similar at both visits. Comparison of characteristic data between patients with COVID-19 at the longitudinal follow-up visit and controls showed similar age (p=0.962), proportion of male sex (p=0.907), ethnicity (p=0.566), family minimum monthly wage (p=0.664), body mass index (p=0.601), and pediatric pre-existing chronic conditions (p=1.000). The Pediatric Quality of Live Inventory 4.0 scores, median physical score (69 [0-100] versus 81 [34-100], p=0.012), and school score (60 [15-100] versus 70 [15-95], p=0.028) were significantly lower in pediatric patients with COVID-19 at the longitudinal follow-up visit than in controls. CONCLUSIONS: Pediatric patients with COVID-19 showed a longitudinal impact on HRQoL parameters, particularly in physical/school domains, reinforcing the need for a prospective multidisciplinary approach for these patients. These data highlight the importance of closer monitoring of children and adolescents by the clinical team after COVID-19.

https://doi.org/10.6061/clinics/2021/e3511

HIV continuum of care among trans women and travestis living in São Paulo, Brazil
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Rocha, Aline Borges Moreira da

; Barros, Cláudia

; Generoso, Igor Prado

; Bastos, Francisco I.

; Veras, Maria Amélia

Revista de Saúde Pública

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2020, Volume 54 elocation 118

Abstract: En | Text: En | PDF: En

ABSTRACT OBJECTIVE: To examine the HIV care cascade among trans women and travestis in São Paulo – Brazil, the most populous city in South America. METHODS: Using data from a cross-sectional study carried out between November 2016 and May 2017 in the city of São Paulo (Divas Research). Respondent driven sampling (RDS) was used to recruit 386 transgender women and travestis who participated in a HIV risk survey and were tested for HIV. The cascade was defined as HIV prevalence, HIV diagnosed, Antiretroviral (ART) Prescription, and currently on ART. A multiple analysis model was conducted to identify the association between sociodemographics and the cascade gaps. RESULTS: Of the trans women living with HIV, 80.9% were already diagnosed, 76.6% of them had been prescribed, of which 90.3% were currently on treatment. Those who were registered in care had a higher rate of ART (aPR 2.06; 95%CI 1.09-3.88). Trans women between 31-40 years old (aPR 1.65; 95%CI 1.09-2.50) and those older than 40 (aPR 1.59; 95%CI 1.04-2.43) had higher prevalence of ART. CONCLUSIONS: Our data suggest an increase in the testing and treatment policy implementation among trans women in the city of São Paulo, although gaps have been found in the linkage to care. However, young trans women and those not registered in health care service may benefit from efforts to engage this part of the population in care to improve HIV treatment and care outcomes.

https://doi.org/10.11606/s1518-8787.2020054002374

10.

HIV continuum of care among trans women and travestis living in São Paulo, Brazil
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Rocha, Aline Borges Moreira da

; Barros, Cláudia

; Generoso, Igor Prado

; Bastos, Francisco I.

; Veras, Maria Amélia

Revista de Saúde Pública

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2020, Volume 54 elocation 118

Abstract: En | Text: En | PDF: En

https://doi.org/10.11606/s1518-8787.2020054002374 359 downloads

11.

Lifetime overweight and adult asthma: 1978/1979 Ribeirão Preto Birth Cohort, São Paulo, Brazil
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Padilha, Luana Lopes

; Ribeiro, Cecilia Claudia Costa

; Nascimento, Joelma Ximenes Prado Teixeira

; Simões, Vanda Maria Ferreira

; Vitti, Fernanda Pino

; Cardoso, Viviane Cunha

; Vianna, Elcio Oliveira

; Barbieri, Marco Antônio

; Silva, Antônio Augusto Moura da

; Bettiol, Heloísa

Cadernos de Saúde Pública

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2020, Volume 36 N. 3 elocation e00041519

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

Os estudos sobre obesidade e asma frequentemente analisam o peso em um determinado momento; portanto, a modelagem de trajetórias de sobrepeso ao longo da vida pode ajudar a explicar os aspectos temporais dessa relação. O estudo atual modelou as trajetórias na associação entre história de sobrepeso e asma na vida adulta, utilizando dados da Coorte de Nascimento de 1978/1979, Ribeirão Preto, São Paulo, Brasil (n = 2.063), coletados ao nascer (linha de base), na idade escolar (9-11 anos) e na idade adulta (23-25 anos). Foi proposto um modelo teórico para explorar a associação entre o sobrepeso ao longo da vida e asma na vida adulta, analisada pela modelagem de equações estruturais. Obesidade dos pais (CP - coeficiente padronizadoglobal = 0,211, p < 0,001; CPdireto = 0,115; p = 0,007) e sobrepeso na idade escolar (CPglobal = 0,565; p < 0,0001; CPdireto = 0,565; p < 0,0001) mostraram associação com sobrepeso na idade adulta. Obesidade dos pais (CPdireto = 0,105; p = 0,047) e estado nutricional ao nascer (CPglobal = - 0,124; p = 0,009; CPdireto = -0,131; p = 0,007) mostraram associação com asma na idade adulta. “Condição socioeconômica” mais alta na vida adulta mostrou associação inversa com sobrepeso (CPdireto = -0,171, p = 0,020) e com asma na vida adulta (CPglobal = -0,179; p = 0,041; CPdireto = -0,182; p = 0,039). Obesidade dos pais mostrou um efeito transgeracional sobre o peso, como gatilho na infância e no sobrepeso na vida adulta. Em paralelo ao baixo peso ao nascer, a obesidade dos pais também esteve associada com asma na vida adulta. A condição socioeconômica na vida adulta mostrou efeito protetor contra sobrepeso e asma.

Studies focusing on obesity and asthma frequently consider the weight at a given time; thus, modeling pathways through lifetime overweight may contribute to elucidate temporal aspects in this relationship. This study modeled the pathways in the association of lifetime overweight with asthma in adult life, using data from the 1978/1979 Birth Cohort, Ribeirão Preto, São Paulo, Brazil (n = 2,063) at birth (baseline), school age (9/11 years) and adult age (23/25 years). A theoretical model was proposed to explore the effects of lifetime overweight on asthma in adult life analyzed by structural equation modeling. Parental obesity (SC - standardized coefficenttotal = 0.211, p < 0.001; SCdirect = 0.115, p = 0.007) and overweight at school age (SCtotal = 0.565, p < 0.0001; SCdirect = 0.565, p < 0.0001) were associated with overweight in adult life. Parental obesity (SCdirect = 0.105, p = 0.047) and nutritional status at birth (SCtotal = -0.124, p = 0.009; SCdirect = -0.131, p = 0.007) were associated with asthma in adult life. A higher “current adult socieconomic situation” was inversely associated to overweight (SCdirect = -0.171, p = 0.020) and to asthma in adult life (SCtotal = -0.179, p = 0.041; SCdirect = -0.182, p = 0.039). Parental obesity showed a transgenerational effect in weight, triggering to childhood and adulthood overweight. Parallel to underweight at birth, parental obesity was also a risk to asthma in adult life. While, the socioeconomic status in adult life protected from both, overweight and asthma.

Los estudios que se centran en la obesidad y asma frecuentemente consideran el peso en un determinado momento; por este motivo, la creación de modelos de patrones de sobrepeso a lo largo de la vida quizás puede contribuir a elucidar aspectos temporales en esta relación. Este estudio modeló los patrones en la asociación de sobrepeso a lo largo de la vida con el asma en etapa adulta, usando datos de una cohorte nacimientos de 1978/1979, en Ribeirão Preto, São Paulo, Brasil (n = 2.063), considerando: nacimiento (base de referencia), edad escolar (9-11 años) y edad adulta (23-25 años). Se propuso un modelo teórico para analizar los efectos del sobrepeso a lo largo de la vida en el asma, durante la etapa adulta, analizado mediante modelos de ecuaciones estructurales. La obesidad de los padres (CE - coeficiente estandarizadototal = 0,211, p < 0,001; CEdirecto = 0,115; p = 0,007) y sobrepeso en edad escolar (CEtotal = 0,565; p < 0,0001; CEdirecto = 0,565; p < 0,0001) estuvieron asociados con sobrepeso en la vida adulta. La obesidad de los padres (CEdirecto = 0,105; p = 0,047) y el estatus nutricional al nacer (CEtotal = - 0,124; p = 0,009; CEdirecto = -0,131; p = 0,007) estuvieron asociados con el asma en la vida adulta. Un “condición socioeconómica actual en la etapa adulta” más alto estuvo inversamente asociado con el sobrepeso (CEdirecto = -0,171; p = 0,020) y al asma en la vida adulta (CEtotal = -0,179; p = 0,041; CEdirect = -0,182; p = 0,039). La obesidad de los padres mostró un efecto transgeneracional en el peso, desencadenando sobrepeso en la infancia y etapa adulta. Junto al bajo peso al nacer, la obesidad de los padres fue también un riesgo para el asma en la etapa adulta. Mientras que el estatus socioeconómico en la etapa adulta protegía tanto ante el sobrepeso como el asma.

https://doi.org/10.1590/0102-311x00041519 745 downloads

12.

Lifetime overweight and adult asthma: 1978/1979 Ribeirão Preto Birth Cohort, São Paulo, Brazil
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Padilha, Luana Lopes

; Ribeiro, Cecilia Claudia Costa

; Nascimento, Joelma Ximenes Prado Teixeira

; Simões, Vanda Maria Ferreira

; Vitti, Fernanda Pino

; Cardoso, Viviane Cunha

; Vianna, Elcio Oliveira

; Barbieri, Marco Antônio

; Silva, Antônio Augusto Moura da

; Bettiol, Heloísa

Cadernos de Saúde Pública

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2020, Volume 36 N. 3 elocation e00041519

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

https://doi.org/10.1590/0102-311x00041519

13.

Clinical and molecular profile of newborns with confirmed or suspicious congenital adrenal hyperplasia detected after a public screening program implementation,
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Kopacek, Cristiane

; Prado, Mayara J.

; Silva, Claudia M.D. da

; Castro, Simone M. de

; Beltrão, Luciana A.

; Vargas, Paula R.

; Grandi, Tarciana

; Rossetti, Maria L.R.

; Spritzer, Poli Mara

Jornal de Pediatria

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jun 2019, Volume 95 N. 3 Pages 282 - 290

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Objetivo: Descrever os resultados obtidos em um programa de triagem neonatal após sua implementação e avaliar os perfis clínicos e moleculares de casos confirmados e suspeitos de hiperplasia adrenal congênita. Métodos: Foi feito um estudo transversal. Recém-nascidos com suspeita da doença devido aos altos níveis de 17-alfa-hidroxiprogesterona e ajustados pelo peso ao nascer foram selecionados. A hiperplasia adrenal congênita clássica (forma perdedora de sal e forma virilizante simples) foi diagnosticada por um aumento nos níveis de 17-alfa-hidroxiprogesterona confirmado no reteste, avaliação clínica e genótipo determinado com o uso do ensaio SNaPshot e amplificação multiplex de sondas dependente de ligação. Resultados: Após 24 meses, 15 casos clássicos de hiperplasia adrenal congênita foram diagnosticados em 217.965 recém-nascidos, com uma incidência estimada de 1:14.531. De 132 pacientes, sete não clássicos e 14 heterozigotos foram submetidos à triagem para mutações no gene CYP21A2 e 96 pacientes apresentaram resultados falso-positivos com CYP21A2 do tipo selvagem. No reteste, níveis aumentados de 17-alfa-hidroxiprogesterona foram encontrados em pacientes com hiperplasia adrenal congênita clássica e mostraram correlação significativa com HAC clássica relacionada ao genótipo. As mutações mais frequentes foram IVS2-13A/C>G, seguidas de deleção gênica ou eventos de rearranjo na forma clássica. Em casos de doenças não clássicas e heterozigose, a mutação p.Val282Leu foi a mais comum. Conclusões: Os resultados ressaltam a eficácia da triagem neonatal para a hiperplasia adrenal congênita no sistema público de saúde e indicam que a estratégia adotada foi adequada. A segunda coleta de amostras, juntamente com a genotipagem dos casos suspeitos, ajudou a diagnosticar adequadamente os casos graves e mais leves e diferenciá-los de pacientes com resultado falso-positivo.

Abstract Objective: To describe the results obtained in a neonatal screening program after its implementation and to assess the clinical and molecular profiles of confirmed and suspicious congenital adrenal hyperplasia cases. Methods: A cross-sectional study was conducted. Newborns with suspected disease due to high 17-hydroxyprogesterone levels and adjusted for birth weight were selected. Classical congenital adrenal hyperplasia (salt-wasting and simple virilizing forms) was diagnosed by an increase in 17-hydroxyprogesterone levels as confirmed in the retest, clinical evaluation, and genotype determined by SNaPshot and multiplex ligation-dependent probe amplification. Results: After 24 months, 15 classic congenital adrenal hyperplasia cases were diagnosed in a total of 217,965 newborns, with an estimated incidence of 1:14,531. From 132 patients, seven non-classical and 14 heterozygous patients were screened for CYP21A2 mutations, and 96 patients presented false positives with wild type CYP21A2. On retest, increased 17-hydroxyprogesterone levels were found in classical congenital adrenal hyperplasia patients and showed significant correlation with genotype-related classical genital adrenal hyperplasia. The most frequent mutations were IVS2-13A/C>G followed by gene deletion or rearrangement events in the classical form. In non-classical and heterozygous diseases, p.Val282Leu was the most common mutation. Conclusions: The results underscore the effectiveness of congenital adrenal hyperplasia neonatal screening in the public health system and indicate that the adopted strategy was appropriate. The second sample collection along with genotyping of suspected cases helped to properly diagnose both severe and milder cases and delineate them from false positive patients.

https://doi.org/10.1016/j.jped.2018.03.003 1464 downloads

14.

Consensus on the therapeutic management of atopic dermatitis - Brazilian Society of Dermatology
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Aoki, Valeria

; Lorenzini, Daniel

; Orfali, Raquel Leão

; Zaniboni, Mariana Colombini

; Oliveira, Zilda Najjar Prado de

; Rivitti-Machado, Maria Cecília

; Takaoka, Roberto

; Weber, Magda Blessmann

; Cestari, Tania

; Gontijo, Bernardo

; Ramos, Andrea Machado Coelho

; Silva, Claudia Marcia de Resende

; Cestari, Silmara da Costa Pereira

; Souto-Mayor, Silvia

; Carneiro, Francisca Regina

; Cerqueira, Ana Maria Mosca de

; Laczynski, Cristina

; Pires, Mario Cezar

Anais Brasileiros de Dermatologia

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apr 2019, Volume 94 N. 2 Pages 67 - 75

Abstract: En | Text: En | PDF: En

Abstract: BACKGROUND: Atopic dermatitis is a highly prevalent inflammatory and pruritic dermatosis with a multifactorial etiology, which includes skin barrier defects, immune dysfunction, and microbiome alterations. Atopic dermatitis is mediated by genetic, environmental, and psychological factors and requires therapeutic management that covers all the aspects of its complex pathogenesis. OBJECTIVES: The aim of this article is to present the experience, opinions, and recommendations of Brazilian dermatology experts regarding the therapeutic management of atopic dermatitis. METHODS: Eighteen experts from 10 university hospitals with experience in atopic dermatitis were appointed by the Brazilian Society of Dermatology to organize a consensus on the therapeutic management of atopic dermatitis. The 18 experts answered an online questionnaire with 14 questions related to the treatment of atopic dermatitis. Afterwards, they analyzed the recent international guidelines on atopic dermatitis of the American Academy of Dermatology, published in 2014, and of the European Academy of Dermatology and Venereology, published in 2018. Consensus was defined as approval by at least 70% of the panel. RESULTS/CONCLUSION: The experts stated that the therapeutic management of atopic dermatitis is based on skin hydration, topical anti-inflammatory agents, avoidance of triggering factors, and educational programs. Systemic therapy, based on immunosuppressive agents, is only indicated for severe refractory disease and after failure of topical therapy. Early detection and treatment of secondary bacterial and viral infections is mandatory, and hospitalization may be needed to control atopic dermatitis flares. Novel target-oriented drugs such as immunobiologicals are invaluable therapeutic agents for atopic dermatitis.

https://doi.org/10.1590/abd1806-4841.2019940210 4086 downloads

15.

Diagnósticos e intervenções de enfermagem para a pessoa com úlcera venosa
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Grasse, Araceli Partelli

; Bicudo, Sheilla Diniz Silveira

; Primo, Cândida Caniçali

; Zucolotti, Cília

; Belonia, Claudia Sumaia Ferreira de Oliveira

; Bringuente, Maria Edla de Oliveira

; Araújo, Thiago Moura de

; Prado, Thiago Nascimento do

Acta Paulista de Enfermagem

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jun 2018, Volume 31 N. 3 Pages 280 - 290

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

Resumo Objetivo Elaborar e validar o Subconjunto terminológico CIPE® para o cuidado à pessoa com úlcera venosa, orientado pela teoria das Necessidades Humanas Básicas de Wanda Aguiar Horta. Métodos Estudo metodológico para elaboração de subconjuntos terminológicos da CIPE®. Inicialmente, fez-se uma revisão integrativa, buscando evidências para a prática de enfermagem à pessoa com úlcera venosa dispostas na literatura, a fim de responder à seguinte pergunta: Quais as evidências empíricas apresentadas na pessoa com úlcera venosa? As bases acessadas foram o Medical Literature Analysis and Retrieval System Online (MEDLINE) e a Literatura Latino-Americana e do Caribe de Informação em Ciências da Saúde (LILACS), e também a Cumulative Index to Nursing and Allied Health Literature (CINAHL). Utilizaram-se os seguintes critérios de inclusão: ter resumo disponível nos idiomas português, inglês ou espanhol; e publicados entre 2012 e 2016. Como critérios de exclusão: relatos de casos, teses, monografias, manuais e trabalhos que não apresentavam manifestações clínicas da úlcera venosa. Resultados 84 diagnósticos, resultados de enfermagem e 306 intervenções foram validados por um grupo de juízes enfermeiros, expertises em tratamento de úlcera venosa. Dos diagnósticos elaborados, 62 são constantes na CIPE® e 23 são novos diagnósticos, não constantes. Conclusão A CIPE® evidenciou-se como uma taxonomia que pode ser compatível e aplicável à clínica do enfermeiro, com potencial para a organização do processo de trabalho, seja no âmbito ambulatorial ou hospitalar.

Abstract Objective To develop and validate the terminological subset of ICNP® for the care of people with venous ulcer guided by Wanda Aguiar Horta’s theory of Basic Human Needs. Methods Methodological study for the development terminological subsets of ICNP®. Initially, was conducted an integrative review in order to search for evidence in the literature for the nursing practice to people with venous ulcer, and answer the following question: What are the empirical evidences found in the person with venous ulcer? The accessed databases were the Medical Literature Analysis and Retrieval System Online (MEDLINE), the Latin American and Caribbean Literature on Health Sciences Information (LILACS), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). Inclusion criteria were the following: abstracts available in Portuguese, English or Spanish; and published between 2012 and 2016. Exclusion criteria were case reports, theses, monographs, manuals and papers that did not present clinical manifestations of venous ulcer. Results A group of nurse judges experienced in the treatment of venous ulcer validated 84 nursing diagnoses and outcomes, and 306 interventions. Of the diagnoses developed, 62 are included in ICNP® and 23 are new diagnoses, not included. Conclusion The ICNP® has proved to be a taxonomy that can be compatible and applicable to nurses’ clinic with potential for organization of the work process, whether in the outpatient or hospital setting.

Resumen Objetivo Elaborar y validar el Subconjunto terminológico CIPE® para el cuidado de la persona con úlcera venosa, orientado por la teoría de las Necesidades Humanas Básicas de Wanda Aguiar Horta. Métodos Estudio metodológico para elaboración de subconjuntos terminológicos de CIPE®. Inicialmente, se realizó revisión integrativa, buscando evidencias de la práctica de enfermería a la persona con úlcera venosa dispuestas en la literatura, para responder la pregunta: ¿Cuáles son las evidencias empíricas presentadas en la persona con úlcera venosa? Se buscó en las bases Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS) y Cumulative Index to Nursing and Allied Health Literature (CINAHL). Se utilizaron los siguientes criterios de inclusión: contar con resumen disponible en portugués, inglés o español; y publicación entre 2012 y 2016. Como criterios de exclusión: relatos de casos, tesis, monografías, manuales y trabajos que no expresaban manifestaciones clínicas de la úlcera venosa. Resultados 84 diagnósticos, resultados de enfermería y 306 intervenciones fueron validadas por un grupo de expertos enfermeros, especializados en tratamiento de úlcera venosa. De los diagnósticos elaborados, 62 constan en la CIPE® y 23 son nuevos. Conclusión La CIPE® se evidenció como taxonomía compatible y aplicable a la clínica del enfermero, con potencial para organización del proceso de trabajo, tanto en el ámbito ambulatorio como hospitalario.

https://doi.org/10.1590/1982-0194201800040 23486 downloads

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