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Ramacciotti E, Ferreira U, Costa AJV, Raymundo SRO, Correa JA, Neto SG, Osvaldt AB, Agati L, Aguiar VCR, Davila R, Caltabiano TB, Magella FM, Volpiani GG, Castelli V, Caffaro RA, DalAcqua LZ, Matheus WE, Sato DY, Russeff GJDS, de Souza DG, Pazetto LE, de Lima TAM, Colnago EMDS, Fugii EY, Mussalem JS, Assao VT, Toffoletto O, Rodrigues DG, Afiune JB, Araujo GR. Efficacy and Safety of a Biosimilar Versus Branded Enoxaparin in the Prevention of Venous Thromboembolism Following Major Abdominal Surgery: A Randomized, Prospective, Single-Blinded, Multicenter Clinical Trial. Clin Appl Thromb Hemost 2018; 24:1208-1215. [PMID: 30021463 PMCID: PMC6714771 DOI: 10.1177/1076029618786583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Several biosimilar versions of enoxaparin are already approved and in use globally. Analytical characterization can establish good quality control in manufacturing, but they may not assure similarity in clinical outcomes between biosimilar and branded enoxaparin. This study evaluated the efficacy and safety of biosimilar Cristália versus branded Sanofi enoxaparin in venous thromboembolism (VTE) prevention in patients undergoing major abdominal surgery at risk for VTE. In this randomized, prospective single-blind study, we compared Cristália enoxaparin (Ce), a biosimilar version, versus branded Sanofi enoxaparin (Se; at a dose of 40 mg subcutaneously per day postoperatively from 7 to 10 days) in 243 patients submitted to major abdominal surgery at risk for VTE for VTE prevention. The primary efficacy outcome was occurrence of VTE or death related to VTE. The principal safety outcomes were a combination of major bleeding and clinically relevant non-major bleeding. Bilateral duplex scanning of the legs was performed from days 10 to 14, and follow-ups were performed up to 60 days after surgery. The incidence of VTE was 4.9% in the Cristália group and 1.1% in the Sanofi group (absolute risk difference = 3.80%, 95% confidence interval [CI]: −1.4%-9.0%) yielding noninferiority since the 95% CI does not reach the prespecified value Δ = 20%. Clinically significant bleeding occurred in 9.9% in the Cristália group and in 5.5% in the Sanofi group (n.s. ). In conclusion, this study suggests that 40 mg once daily of Ce, a biosimilar enoxaparin, is as effective and safe as the branded Sanofi enoxaparin in the prophylaxis of VTE in patients submitted to major abdominal surgery at risk for VTE.
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Affiliation(s)
- Eduardo Ramacciotti
- 1 Vascular Surgery, Hospital e Maternidade Dr. Christóvão da Gama, Santo André, São Paulo, Brazil.,2 Loyola University Medical Center, Maywood, IL, USA
| | - Ubirajara Ferreira
- 3 Oncological Urology Group-FCM-UNICAMP-Universidade Estadual de Campinas, São Paulo, Brazil
| | - Agenor José Vasconcelos Costa
- 4 Vascular Surgery Department, Hospital Estadual Mário Covas, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil
| | | | - João Antônio Correa
- 6 Vascular Surgery, Hospital de Ensino da Faculdade de Medicina do ABC, São Paulo, Brazil
| | - Salvador Gullo Neto
- 7 Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Leandro Agati
- 1 Vascular Surgery, Hospital e Maternidade Dr. Christóvão da Gama, Santo André, São Paulo, Brazil
| | | | - Ronaldo Davila
- 1 Vascular Surgery, Hospital e Maternidade Dr. Christóvão da Gama, Santo André, São Paulo, Brazil.,9 Vascular Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | | | - Flávia Magalhães Magella
- 1 Vascular Surgery, Hospital e Maternidade Dr. Christóvão da Gama, Santo André, São Paulo, Brazil
| | - Giuliano Giova Volpiani
- 1 Vascular Surgery, Hospital e Maternidade Dr. Christóvão da Gama, Santo André, São Paulo, Brazil.,9 Vascular Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Valter Castelli
- 9 Vascular Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | | | - Lucas Zeponi DalAcqua
- 3 Oncological Urology Group-FCM-UNICAMP-Universidade Estadual de Campinas, São Paulo, Brazil
| | - Wagner Eduardo Matheus
- 3 Oncological Urology Group-FCM-UNICAMP-Universidade Estadual de Campinas, São Paulo, Brazil
| | - Debora Yuri Sato
- 5 Fundação Faculdade Regional de Medicina de São José do Rio Preto, São Paulo, Brazil
| | | | | | - Lucas Eduardo Pazetto
- 5 Fundação Faculdade Regional de Medicina de São José do Rio Preto, São Paulo, Brazil
| | | | | | - Eliane Yumii Fugii
- 6 Vascular Surgery, Hospital de Ensino da Faculdade de Medicina do ABC, São Paulo, Brazil
| | | | | | - Odaly Toffoletto
- 10 Cristália Produtos Químicos Farmacêuticos LTDA, São Paulo, Brazil
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Conde MB, Melo FAFD, Marques AMC, Cardoso NC, Pinheiro VGF, Dalcin PDTR, Machado Junior A, Lemos ACM, Netto AR, Durovni B, Sant'Anna CC, Lima D, Capone D, Barreira D, Matos ED, Mello FCDQ, David FC, Marsico G, Afiune JB, Silva JRLE, Jamal LF, Telles MADS, Hirata MH, Dalcolmo MP, Rabahi MF, Cailleaux-Cesar M, Palaci M, Morrone N, Guerra RL, Dietze R, Miranda SSD, Cavalcante SC, Nogueira SA, Nonato TSG, Martire T, Galesi VMN, Dettoni VDV. III Brazilian Thoracic Association Guidelines on tuberculosis. J Bras Pneumol 2010; 35:1018-48. [PMID: 19918635 DOI: 10.1590/s1806-37132009001000011] [Citation(s) in RCA: 134] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Accepted: 08/25/2009] [Indexed: 11/21/2022] Open
Abstract
New scientific articles about tuberculosis (TB) are published daily worldwide. However, it is difficult for health care workers, overloaded with work, to stay abreast of the latest research findings and to discern which information can and should be used in their daily practice on assisting TB patients. The purpose of the III Brazilian Thoracic Association (BTA) Guidelines on TB is to critically review the most recent national and international scientific information on TB, presenting an updated text with the most current and useful tools against TB to health care workers in our country. The III BTA Guidelines on TB have been developed by the BTA Committee on TB and the TB Work Group, based on the text of the II BTA Guidelines on TB (2004). We reviewed the following databases: LILACS (SciELO) and PubMed (Medline). The level of evidence of the cited articles was determined, and 24 recommendations on TB have been evaluated, discussed by all of the members of the BTA Committee on TB and of the TB Work Group, and highlighted. The first version of the present Guidelines was posted on the BTA website and was available for public consultation for three weeks. Comments and critiques were evaluated. The level of scientific evidence of each reference was evaluated before its acceptance for use in the final text.
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Silva AC, Toffoletto O, Lucio LAG, Santos PFD, Afiune JB, Massud Filho J, Tufik S. Repercussão cardiovascular, com e sem álcool, do carbonato de lodenafila, um novo inibidor da PDE5. Arq Bras Cardiol 2010. [DOI: 10.1590/s0066-782x2010000200004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Silva AC, Toffoletto O, Lucio LAG, Santos PFD, Afiune JB, Massud Filho J, Tufik S. Cardiovascular repercussion of lodenafil carbonate, a new PDE5 inhibitor, with and without alcohol consumption. Arq Bras Cardiol 2010; 94:150-158. [PMID: 20428608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Accepted: 09/18/2008] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Millions of men around the world suffer from erectile dysfunction, for which phosphodiesterase 5 inhibitors (PDE-5 inhibitors) are currently the first treatment option. Sexual activity and alcohol consumption are closely related, and the simultaneous use of alcohol and PDE-5 inhibitors can happen. Lodenafil carbonate is a new PDE-5 inhibitor, developed by a Brazilian pharmaceutical company. OBJECTIVE This work aimed at evaluating the cardiovascular safety of lodenafil carbonate, with and without simultaneous alcohol consumption. METHODS Fifteen male volunteers received 160 mg lodenafil carbonate (LC), in three different moments. Participants were assigned to three groups, treated with LC in fasting condition, with alcohol or receiving only placebo. The volunteers were continuously monitored during 24 hours for physical impairment, blood pressure, heart rate, QT interval and lodenafil's pharmacokinetic parameters. RESULTS Lodenafil carbonate alone or with alcohol did not induce clinically relevant modifications in arterial blood pressure or heart rate. A statistically significant decrease in blood pressure was seen four hours after LC and alcohol intake, and an increase in heart rate six hours after intake of lodenafil carbonate alone. The QTc interval was not significantly modified. Lodenafil carbonate bioavailability was increased in 74% when drug intake was associated with alcohol. CONCLUSION These results show that the use of lodenafil carbonate did not have clinically relevant effects on blood pressure or heart rate, and was not associated with QT interval prolongation. The association of lodenafil carbonate and alcohol affected its pharmacokinetic properties, increasing the bioavailability of the drug.
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Barretto MGP, Costa MDGNF, Serra MCDVF, Afiune JB, Praxedes HEP, Pagani E. Estudo comparativo entre tratamento convencional e tratamento com heparina tópica para a analgesia de queimaduras. Rev Assoc Med Bras (1992) 2010; 56:51-5. [DOI: 10.1590/s0104-42302010000100016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Accepted: 10/04/2009] [Indexed: 11/22/2022] Open
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Abstract
A variety of diseases are encompassed in the didactic denomination of "granulomatous diseases of probable occupational etiology". As well as presenting similar clinical aspects, such diseases are characterized by certain common traits: formation of granulomas; systemic and respiratory manifestations; environmental or occupational exposure to organic or inorganic agents; and T lymphocyte involvement in the pathogenesis. Included in this category are hypersensitivity pneumonitis, mycobacteriosis (all forms) and sarcoidosis, as well as beryllium disease and other lung diseases caused by exposure to heavy metals. In order to highlight the risk of developing one of these diseases as a result of environmental or occupational exposure to etiologic agents, we address aspects related to epidemiology, pathogenesis and evaluation of exposure of these diseases, as well as those related to diagnostic criteria, prevention and control. We have given special emphasis to groups of individuals considered to be at high risk for developing these diseases, as well as to the need for health care professionals to remain aware of the potential occupational etiology of such diseases, a decisive factor in devising effective measures of prevention and epidemiological surveillance.
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Affiliation(s)
- Ericson Bagatin
- Departamento de Medicina Preventiva e Social, Faculdade de Ciência Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil.
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Almeida EAD, Santos MAAD, Afiune JB, Spada DTDA, Melo FAFD. Rendimento da cultura de escarro na comparação de um sistema de diagnóstico automatizado com o meio de Lowenstein-Jensen para o diagnóstico da tuberculose pulmonar. J Bras Pneumol 2005. [DOI: 10.1590/s1806-37132005000300009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: A tuberculose permanece um problema de saúde pública mundial. OBJETIVO: Avaliar um sistema de diagnóstico automatizado de tuberculose, comparando-o com baciloscopia e cultura em meio de Lowenstein-Jensen. MÉTODO: Estudo comparativo entre os resultados obtidos no sistema automatizado, baciloscopia do escarro e em meio de Lowenstein-Jensen, em 844 amostras de escarro de setembro a dezembro de 1999, em centro de referência para tuberculose em São Paulo (SP). RESULTADOS: Das 844 amostras, 27,1% mostraram-se positivas para bacilo álcool-acidorresistente e 72,9% negativas. Nos cultivos em Lowenstein-Jensen, 34,7% foram positivas e 63% negativas; no sistema automatizado, 37,1% foram positivas e 56,9% negativas. Observou-se sensibilidade de 98,1% e 91.9% no sistema automatizado e no Lowenstein-Jensen, respectivamente. A especificidade e o valor preditivo positivo foram de 100% nos dois métodos. O valor preditivo negativo foi de 98,9% no sistema automatizado e de 95,5% no Lowenstein-Jensen. A acurácia foi de 99,3% no sistema automatizado e 97% no Lowenstein-Jensen e o Kappa de 0,99 no sistema automatizado e 0,94 no Lowenstein-Jensen. O tempo médio de detecção das micobactérias no sistema automatizado (10,5 dias) apresentou diferença estatística significativa quando comparado com o método de Lowenstein-Jensen (34,7 dias). CONCLUSÃO: O rendimento da cultura com o sistema automatizado apresentou diferença estatística significativa quando comparado com o meio de Lowenstein-Jensen. O tempo médio de detecção das micobactérias foi significativamente reduzido no sistema automatizado. O rendimento do sistema automatizado justifica sua utilização em unidade de referência ambulatorial para a tuberculose em São Paulo.
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Castro AZ, Diaz-Bardalez BM, Oliveira EC, Garcia RC, Afiune JB, Paschoal IA, Santos LMB. Abnormal production of transforming growth factor beta and interferon gamma by peripheral blood cells of patients with multidrug-resistant pulmonary tuberculosis in Brazil. J Infect 2004; 51:318-24. [PMID: 16291285 DOI: 10.1016/j.jinf.2004.08.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2004] [Accepted: 08/31/2004] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of the present study was to determine the immune response profile that differentiates patients with newly diagnosed (non-treated) pulmonary tuberculosis from multidrug-resistant (MDR) ones, as well as from healthy, tuberculin positive individuals. METHODS Lymphocytes proliferative response to non-specific mitogen (PHA) and PPD were evaluated by 3H thymidine incorporation and cytokines were quantified using an ELISA assay. RESULTS Patients with active disease showed a diminished proliferative response to PHA and PPD, while multidrug-resistant patients showed a diminished proliferative response to PHA, but a normal response to PPD. The cytokine production of newly diagnosed patients was characterized by a diminished production of IFNgamma and normal production of transforming growth factor (TGFbeta), while MDR patients revealed a normal production of IFNgamma accompanied by an increase in TGFbeta. CONCLUSIONS The production of significant amounts of TGFbeta in MDR patients leads to a poor immune response and may contribute to the resistance of tuberculosis patients to drugs.
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Affiliation(s)
- Analia Z Castro
- Department of Microbiology and Immunology, University of Campinas, UNICAMP, Campinas, CEP 13083 970 São Paulo, SP, Brazil
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Melo FAFD, Afiune JB, Ide Neto J, Almeida EAD, Spada DTA, Antelmo ANL, Cruz ML. Aspectos epidemiológicos da tuberculose multirresistente em serviço de referência na cidade de São Paulo. Rev Soc Bras Med Trop 2003. [DOI: 10.1590/s0037-86822003000100005] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Com o objetivo de estudar algumas características epidemiológicas dos portadores de tuberculose pulmonar multirresistente e suas influências sobre o controle e o tratamento, foi avaliada uma coorte de 4 anos de pacientes selecionados pela recuperação do Mycobacterium tuberculosis no escarro, resistência à rifampicina, isoniazida e mais uma terceira droga usual ou falência do esquema de reserva, matriculados em uma referência na cidade de São Paulo. As variáveis estudadas foram: sexo e idade, tipo de multirresistência, contágio, condições associadas, perfil de resistência às drogas usuais e distribuição das lesões na radiologia convencional. Revistos 182 pacientes, 112 (61,5%) masculinos, com idade variando entre 16 e 64 anos (35,7±6,8). Com base na história terapêutica foram discriminados os seguintes tipos: MR-primária (com teste de sensibilidade inicial), 11 (6%), MR-pós-primária (irregularidade no tratamento anterior), 134 (74%) e MR-indeterminada (falência após uso regular informado dos esquemas usuais), 37 (20%). Contágio presente em 41 de 170 pacientes, predominando o intradomiciliar sobre o institucional. Identificados 4 surtos familiares e nenhum institucional. O abandono (45%) foi a mais freqüente condição associada, seguido do etilismo (27%), falência seqüencial aos esquemas de retratamento (23%), contágio com multirresistência (15%), reações adversas às drogas (6%), HIV-positivo (4%) e diabetes (3%). Resistência à rifampiina+isoniazida em 100%, 83% à estreptomicina e 47% ao etambutol. Todos com cavidades no Rx de tórax convencional, unilaterais em 35 (19%). Discutem-se os achados e apresentam-se sugestões.
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de Melo FAF, Afiune JB, Ide Neto J, de Almeida EA, Spada DTA, Antelmo ANL, Cruz ML. [Epidemiological features of multidrug-resistant tuberculosis in a reference service in São Paulo city]. Rev Soc Bras Med Trop 2003; 36:27-34. [PMID: 12715060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
In order to study certain epidemiological features of multidrug-resistant tuberculosis (MDR-TB) carriers and their influence on the control and treatment, a group of patients was evaluated over a four-year period, selected by: Mycobacterium tuberculosis isolation from sputum; resistance to Rifampin, Isoniazid and one more drug, or, failure of reserve regimen, all cases were from a tuberculosis reference unit in the City of S o Paulo. A total of 182 patients were reviewed, with a mean age of 35.7 +/- 6.8 years and 112 (61.5%) were male. These patients was classified according to therapeutic history, as: primary MDR-TB (with initial sensitivity test) 11 (6%); post primary MDR-TB (after irregular use previous treatment) 134 (74%), and indeterminate MDR-TB (failure after regular use of initial and reserve regimens) 37 (20%). Contagion was identified in 41/170 patients, acquired through domiciliary rather than institutional transmission. There were four familial outbreaks and none were institutional. The most frequent condition associated with these cases was abandonment of therapy (45%) followed by alcoholism (27%), sequential failure in the treatment regimens (23%), MDR contagion (15%), drug reaction (6%), HIV positive (4%) and diabetes (3%). There was resistance to Rifampin+Isoniazid in 100%, Streptomycin in 83% and Ethambutol in 47%. Conventional X-ray revealed cavities in all, though only 35 (19%) were unilateral. These cases are discussed and some suggestions presented.
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Affiliation(s)
- Fernando Augusto Fiuza de Melo
- Divisão de Tisiologia e Pneumologia Sanitária, Instituto Clemente Ferreira da Secretaria de Estado da Saúde de São Paulo, São Paulo, SP, Brasil.
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Ferrazoli L, Palaci M, Marques LR, Jamal LF, Afiune JB, Chimara E, Martins MC, Silva Telles MA, Oliveira CA, Palhares MC, Spada DT, Riley LW. Transmission of tuberculosis in an endemic urban setting in Brazil. Int J Tuberc Lung Dis 2000; 4:18-25. [PMID: 10654639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
SETTING Two out-patient facilities in São Paulo, Brazil. OBJECTIVE To study the transmission pattern of tuberculosis (TB) among human immunodeficiency virus (HIV) infected and uninfected persons in a setting endemic for TB. DESIGN A prospective study comparing HIV-seropositive and -seronegative TB patients identified consecutively between 1 March 1995 and 1 April 1997. The patients were stratified according to their Mycobacterium tuberculosis isolate IS6110 RFLP patterns. Risk factors were sought for infection with an RFLP cluster pattern strain, inferred to represent recent transmission. RESULTS Fifty-eight (38%) of 151 HIV-seropositive patients and 36 (25%) of 142 HIV-seronegative patients were infected with M. tuberculosis isolates that belonged to cluster patterns (OR 1.84, 95% CI 1.08-3.13). Multidrug-resistant (MDR) strains were isolated from 19 patients, all of whom were HIV seropositive; 12 (63%) of these, and 46 (35%) of 132 drug-susceptible isolates had cluster patterns (OR 3.20, 95% CI 1.08-9.77). CONCLUSION In a TB-endemic urban setting in Brazil, the proportion of cases resulting from recent transmission appears to be greater among HIV-seropositive than among HIV-seronegative patients. A large proportion of MDR-TB (63%) cases was caused by strains that had cluster RFLP patterns, suggesting recent transmission of already resistant organisms. This type of knowledge regarding TB transmission may help to improve locally appropriate TB control programs.
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Affiliation(s)
- L Ferrazoli
- Instituto Adolfo Lutz, Divisão de Biologia Médica, São Paulo, Brazil.
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