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s&#227;o gl&#226;ndulas seb&#225;ceas localizadas nas p&#225;lpebras&#44; respons&#225;veis pela secre&#231;&#227;o de lip&#237;deos que desempenham um papel importante na superf&#237;cie ocular&#44; evitando a evapora&#231;&#227;o das l&#225;grimas&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A disfun&#231;&#227;o da gl&#226;ndula meibomiana &#40;DGM&#41; &#233; doen&#231;a cr&#244;nica caracterizada por obstru&#231;&#227;o do ducto terminal e&#47;ou altera&#231;&#245;es quantitativo&#8208;qualitativas nas secre&#231;&#245;es&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> A preval&#234;ncia de DGM varia entre 3&#44;5 e 74&#44;5&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#44;11</span></a> Obstru&#231;&#227;o da GM&#44; as secre&#231;&#245;es meibomianas&#44; telangiectasias&#44; perda da gl&#226;ndula&#44; bem como combina&#231;&#227;o de alguns desses par&#226;metros foram usadas para diagnosticar a DGM&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">12&#44;13</span></a> Uma rela&#231;&#227;o significativa foi encontrada entre a psor&#237;ase e a DGM em estudos&#59; no entanto&#44; a meibografia n&#227;o foi utilizada nos estudos com psor&#237;ase&#44; embora essa abordagem n&#227;o invasiva agora seja amplamente preferida para uso cl&#237;nico e tenha possibilitado a realiza&#231;&#227;o de muitos estudos cl&#237;nicos sobre doen&#231;as da gl&#226;ndula meibomiana&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">14&#8211;16</span></a> Al&#233;m disso&#44; a meibografia permite uma observa&#231;&#227;o objetiva das gl&#226;ndulas meibomianas&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A DGM pode causar ou exacerbar os sintomas do olho seco&#59; 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alergia&#44; altera&#231;&#245;es da superf&#237;cie ocular&#44; hist&#243;ria de cirurgia ou les&#227;o ocular&#44; usu&#225;rios de medicamentos t&#243;picos ou sist&#234;micos que podem afetar a superf&#237;cie ocular e usu&#225;rios de lentes de contato foram exclu&#237;dos do nosso estudo&#46; Pacientes com qualquer doen&#231;a dermatol&#243;gica diferente de psor&#237;ase em placas e aqueles com doen&#231;as sist&#234;micas e neoplasias malignas&#44; e pacientes com hist&#243;rico de tratamento com psolareno<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>ultravioleta A &#40;PUVA&#41; n&#227;o foram inclu&#237;dos no estudo&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Diagn&#243;stico e avalia&#231;&#227;o da gravidade da psor&#237;ase</span><p id="par0040" class="elsevierStylePara elsevierViewall">A gravidade da doen&#231;a foi avaliada utilizando&#8208;se o &#205;ndice de &#193;rea e Gravidade da Psor&#237;ase &#40;PASI&#44; do ingl&#234;s <span class="elsevierStyleItalic">Psoriasis Area and Severity Index</span>&#41;&#46; A gravidade da psor&#237;ase em placas foi classificada como doen&#231;a leve e moderada a grave&#46; A doen&#231;a leve foi definida como PASI &#8804; 10&#44; e a doen&#231;a moderada a grave foi agrupada como PASI &#62;<span class="elsevierStyleHsp" style=""></span>10&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> As caracter&#237;sticas demogr&#225;ficas e os escores m&#233;dios do PASI foram registrados e documentados&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Diagn&#243;stico e avalia&#231;&#227;o das doen&#231;as oculares</span><p id="par0045" class="elsevierStylePara elsevierViewall">Os exames e testes foram realizados sequencialmente da seguinte forma&#58; as p&#225;lpebras superiores e inferiores foram avaliadas com um microsc&#243;pio para presen&#231;a de obstru&#231;&#227;o&#44; telangiectasia&#44; margens irregulares da p&#225;lpebra &#40;chanfradura ou <span class="elsevierStyleItalic">notching</span>&#41; e deslocamento da jun&#231;&#227;o mucocut&#226;nea&#46; Ap&#243;s o exame&#44; foram realizados colora&#231;&#227;o da superf&#237;cie ocular com fluoresce&#237;na&#44; teste do tempo de ruptura do filme lacrimal &#40;BUT&#44; do ingl&#234;s <span class="elsevierStyleItalic">Break&#8208;Up Time</span>&#41;&#44; teste de Schirmer e meibografia&#46; Os resultados desses testes foram registrados&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Os crit&#233;rios diagn&#243;sticos recomendados pelo MGD Study Group no Jap&#227;o foram utilizados para o diagn&#243;stico da DGM&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> A DGM foi diagnosticada quando a GM estava oclu&#237;da e havia anormalidades nas margens da p&#225;lpebra&#46; O BG&#8208;4<span class="elsevierStyleHsp" style=""></span>M <span class="elsevierStyleItalic">Non&#8208;Contact System</span> foi utilizado na meibografia &#40;Sirius&#44; <span class="elsevierStyleItalic">Costruzione Strumenti Oftalmici</span>&#44; Firenze&#44; It&#225;lia&#41;&#46; A avalia&#231;&#227;o da GM foi realizada com o aux&#237;lio de imagens de infravermelho de um biomicrosc&#243;pio com l&#226;mpada de fenda e uma c&#226;mera de v&#237;deo&#46; A taxa de perda da gl&#226;ndula meibomiana &#40;PGM&#41; para a &#225;rea total das gl&#226;ndulas foi calculada utilizando&#8208;se um <span class="elsevierStyleItalic">software</span>&#46; Com esse <span class="elsevierStyleItalic">software</span>&#44; o examinador marcava a &#225;rea total e a perda de &#225;rea&#44; e o percentual da PGM era calculado pelo <span class="elsevierStyleItalic">software</span>&#46; PGM foi registrada como grau 0 &#40;sem perda da GM&#41;&#44; grau 1 &#40;0 a 1&#47;3<span class="elsevierStyleHsp" style=""></span>da GM total&#41;&#44; grau 2 &#40;1&#47;3 a 2&#47;3<span class="elsevierStyleHsp" style=""></span>da GM total&#41; e grau 3 &#40;&#62; 2&#47;3<span class="elsevierStyleHsp" style=""></span>da GM total&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> A classifica&#231;&#227;o da PGM foi realizada com cegamento&#44; pelo mesmo pesquisador&#46; A distor&#231;&#227;o da GM foi registrada como 0 &#40;&#60; 50&#37; de altera&#231;&#245;es&#41; ou 1 &#40;&#62; 50&#37; de altera&#231;&#245;es&#41;&#46; Os escores na meibografia e a distor&#231;&#227;o da GM para as p&#225;lpebras superiores e inferiores foram avaliados para o olho direito&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">O diagn&#243;stico da doen&#231;a do olho seco foi verificado utilizando&#8208;se os crit&#233;rios <span class="elsevierStyleItalic">Tear Film &#38; Ocular Surface Society Dry Eye Workshop II</span> &#40;TFOS DEWS II&#41; modificados&#58; o &#237;ndice de doen&#231;a da superf&#237;cie ocular &#40;OSDI&#44; do ingl&#234;s <span class="elsevierStyleItalic">ocular surface disease index</span>&#41; &#62;<span class="elsevierStyleHsp" style=""></span>13 mais um no teste BUT &#60;<span class="elsevierStyleHsp" style=""></span>10 s&#44; escore do teste de Schirmer &#60;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>mm ou colora&#231;&#227;o da c&#243;rnea e conjuntiva &#62;<span class="elsevierStyleHsp" style=""></span>0&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> O teste BUT&#44; teste de Schirmer e colora&#231;&#227;o da c&#243;rnea e conjuntiva foram realizados no olho direito&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">An&#225;lise estat&#237;stica</span><p id="par0060" class="elsevierStylePara elsevierViewall">A an&#225;lise estat&#237;stica foi realizada com o <span class="elsevierStyleItalic">software</span> SPSS&#44; vers&#227;o 23&#46;0 para Windows &#40;SPSS Inc&#46;&#44; Chicago&#44; IL&#44; EUA&#41;&#46; O teste de Shapiro&#8208;Wilk foi usado para avaliar se a distribui&#231;&#227;o dos dados num&#233;ricos era normal&#46; O teste <span class="elsevierStyleItalic">t</span> para amostras independentes &#40;para uma distribui&#231;&#227;o normal&#41; e o teste de Mann&#8208;Whitney &#40;distribui&#231;&#227;o n&#227;o normal&#41; foram utilizados para comparar as m&#233;dias das vari&#225;veis num&#233;ricas entre os dois grupos&#46; O teste de qui&#8208;quadrado foi usado para comparar as m&#233;dias das vari&#225;veis categ&#243;ricas entre os dois grupos&#46; A an&#225;lise de correla&#231;&#227;o de Spearman foi usada para determinar a rela&#231;&#227;o entre as vari&#225;veis num&#233;ricas que apresentavam distribui&#231;&#227;o normal&#46; An&#225;lises de regress&#227;o log&#237;stica bin&#225;ria foram aplicadas para calcular os <span class="elsevierStyleItalic">odds ratios</span> para as associa&#231;&#245;es entre as vari&#225;veis explicativas&#59; valores de p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 foram considerados estatisticamente significativos&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0065" class="elsevierStylePara elsevierViewall">Os pacientes com diagn&#243;stico de psor&#237;ase &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#41; neste estudo inclu&#237;ram 26 &#40;52&#37;&#41; mulheres e 24 &#40;48&#37;&#41; homens&#44; e a m&#233;dia de idade dos 50 pacientes era de 43&#44;4 &#177;<span class="elsevierStyleHsp" style=""></span>14&#44;1 &#40;varia&#231;&#227;o&#44; 18&#8208;65&#41; anos&#46; Al&#233;m disso&#44; 25 indiv&#237;duos &#40;50&#37;&#41; do grupo controle eram do sexo feminino e 25 &#40;50&#37;&#41; do sexo masculino&#46; A m&#233;dia de idade do grupo controle &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#41; era de 41&#44;2 &#177;<span class="elsevierStyleHsp" style=""></span>8&#44;1 &#40;varia&#231;&#227;o&#44; 21&#8208;65&#41; anos&#46; N&#227;o houve diferen&#231;as estatisticamente significativas na idade e sexo entre os dois grupos &#40;p &#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">De acordo com a anamnese cl&#237;nica&#44; 4 dos 50 pacientes &#40;8&#37;&#41; apresentavam sintomas oculares subjetivos&#44; como prurido&#44; sensa&#231;&#227;o de queima&#231;&#227;o e ard&#234;ncia&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">A frequ&#234;ncia de DGM foi de 28&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#41; no grupo com psor&#237;ase e 6&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41; no grupo controle &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;008&#41;&#46; Uma compara&#231;&#227;o da oclus&#227;o da gl&#226;ndula meibomiana&#44; telangiectasia&#44; deslocamento da jun&#231;&#227;o mucocut&#226;nea e irregularidade da margem da p&#225;lpebra &#40;chanfradura&#41; &#233; apresentada na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">A PGM era de 29&#44;5&#37; no grupo com psor&#237;ase e 9&#44;5&#37; no grupo controle &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; A compara&#231;&#227;o dos escores superior e inferior na meibografia &#233; mostrada na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46; N&#227;o foram detectadas diferen&#231;as na distor&#231;&#227;o da GM entre os grupos &#40;p &#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">A frequ&#234;ncia de DOS no grupo com psor&#237;ase era de 22&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41;&#44; enquanto no grupo controle era de 6&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;044&#41;&#46; A compara&#231;&#227;o do OSDI&#44; teste BUT&#44; teste de Schirmer e o escore na colora&#231;&#227;o da c&#243;rnea &#233; apresentada na <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">O teste de correla&#231;&#227;o de Spearman foi realizado entre PGM&#44; escores PASI e a dura&#231;&#227;o da psor&#237;ase&#46; Uma correla&#231;&#227;o significativa positiva foi encontrada entre os escores PGM e PASI &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;608&#41;&#44; bem como a dura&#231;&#227;o da psor&#237;ase &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;547&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">A rela&#231;&#227;o entre a DGM e idade&#44; sexo&#44; dura&#231;&#227;o da psor&#237;ase e escores PASI foi avaliada atrav&#233;s do teste de regress&#227;o log&#237;stica binomial&#46; Uma rela&#231;&#227;o significativa foi encontrada entre os escores DGM e PASI &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#44; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;211&#41;&#46; N&#227;o foi observada rela&#231;&#227;o significativa entre idade&#44; sexo e dura&#231;&#227;o da psor&#237;ase &#40;p &#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#59; <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">A rela&#231;&#227;o entre DOS e idade&#44; sexo&#44; dura&#231;&#227;o da psor&#237;ase e escores PASI foi avaliada atrav&#233;s do teste de regress&#227;o log&#237;stica binomial&#46; Foi encontrada uma rela&#231;&#227;o significativa entre DOS e idade &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;023&#44; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;073&#41;&#46; N&#227;o foi observada rela&#231;&#227;o significativa entre sexo&#44; tempo de psor&#237;ase e escores PASI &#40;p &#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#59; <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discuss&#227;o</span><p id="par0105" class="elsevierStylePara elsevierViewall">Nossos dados representam o primeiro relato sobre PGM&#44; DGM e DOS mais elevados em pacientes com psor&#237;ase do que na popula&#231;&#227;o saud&#225;vel com o uso da t&#233;cnica da meibografia e sua rela&#231;&#227;o positiva com a gravidade da doen&#231;a&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Em estudos anteriores sobre psor&#237;ase e DGM realizados sem meibografia&#44; de acordo com diferentes crit&#233;rios diagn&#243;sticos&#44; verificou&#8208;se uma alta taxa de DGM em pacientes com psor&#237;ase&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">14&#44;15</span></a> Zengin et al&#46; realizaram um estudo com 70 pacientes com psor&#237;ase&#44; e verificaram que os pacientes com psor&#237;ase apresentavam mais obstru&#231;&#227;o&#44; &#237;ndices de espessura e um volume normal de secre&#231;&#227;o da gl&#226;ndula meibomiana&#46; Eles declararam que um tipo obstrutivo de DGM pode resultar do aumento da renova&#231;&#227;o do epit&#233;lio que reveste o ducto da gl&#226;ndula meibomiana em pacientes com psor&#237;ase&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> Aragona et al&#46; realizaram um estudo com 66 pacientes com psor&#237;ase&#44; e verificaram deteriora&#231;&#227;o significativa nos testes de superf&#237;cie ocular&#44; como altera&#231;&#227;o da camada lip&#237;dica do filme lacrimal&#44; instabilidade do filme lacrimal&#44; les&#245;es epiteliais da c&#243;rnea e conjuntiva e leve metaplasia escamosa na citologia de <span class="elsevierStyleItalic">imprint</span> no grupo de pacientes comparados com os participantes saud&#225;veis&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> De acordo com os crit&#233;rios do MGD Study Group no Jap&#227;o&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> a frequ&#234;ncia de DGM no presente estudo foi significativamente maior&#44; afetando 28&#37; dos pacientes com psor&#237;ase&#44; o que foi consistente com a literatura&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Anormalidades no teste do olho seco em pacientes com psor&#237;ase foram demonstradas em v&#225;rios estudos&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">19&#8211;21</span></a> Ghalamkarpour et al&#46; realizaram um estudo com 200 pacientes psori&#225;sicos e 100 controles saud&#225;veis&#44; e verificaram que os valores m&#233;dios dos testes BUT e Schirmer em pacientes com psor&#237;ase foram significativamente menores do que nos controles&#44; e escores significativamente maiores do OSDI foram observados nos pacientes em compara&#231;&#227;o com os controles&#46; A doen&#231;a do olho seco foi observada com maior frequ&#234;ncia nos pacientes do que no grupo saud&#225;vel&#46; Eles sugeriram que a inflama&#231;&#227;o sist&#234;mica em pacientes com psor&#237;ase pode desempenhar um papel importante nas anormalidades do olho seco&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a> Demirci et al&#46; realizaram um estudo com 30 pacientes com psor&#237;ase e 30 controles&#44; e verificaram que os valores de osmolaridade lacrimal&#44; OSDI&#44; escores da escala de Oxford eram significativamente mais elevados e o escore no teste BUT foi significativamente menor no grupo de pacientes em compara&#231;&#227;o com o grupo controle saud&#225;vel&#46; Eles sugeriram que a psor&#237;ase pode afetar a osmolaridade da l&#225;grima e a fun&#231;&#227;o do filme lacrimal atrav&#233;s de processos inflamat&#243;rios&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> Em estudo de Santos da Cruz et al&#46;&#44; com 43 pacientes com psor&#237;ase e 86 controles&#44; verificou&#8208;se que os pacientes com psor&#237;ase tinham taxa estatisticamente maior de olho seco &#40;16&#44;28&#37;&#41;&#44; prov&#225;vel olho seco &#40;32&#44;56&#37;&#41; e blefarite &#40;16&#44;28&#37;&#41; e doen&#231;a da superf&#237;cie ocular e os testes de Rosa Bengala foram mais anormais em pacientes com psor&#237;ase&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> No presente estudo&#44; de acordo com os crit&#233;rios do TFOS DEWS II&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> a frequ&#234;ncia de DOS foi significativamente maior em 22&#37; dos pacientes com psor&#237;ase&#44; o que est&#225; de acordo com a literatura&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">O mecanismo pelo qual a psor&#237;ase induz a DGM ainda n&#227;o foi esclarecido&#46; A psor&#237;ase &#233; doen&#231;a inflamat&#243;ria cr&#244;nica da pele&#44; caracterizada por hiperprolifera&#231;&#227;o e hiperqueratiniza&#231;&#227;o epid&#233;rmicas&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> Uma grande quantidade de c&#233;lulas &#233; produzida nessa doen&#231;a&#59; essas altera&#231;&#245;es podem ocorrer nas gl&#226;ndulas meibomianas e resultar na obstru&#231;&#227;o das gl&#226;ndulas e na DGM&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">14&#44;15&#44;20&#44;21</span></a> A diminui&#231;&#227;o das secre&#231;&#245;es meibomianas devido &#224; DGM no grupo com psor&#237;ase pode ter resultado no aumento da evapora&#231;&#227;o da l&#225;grima&#46; Al&#233;m disso&#44; a DOS pode ter ocorrido em raz&#227;o do aumento da osmolaridade lacrimal decorrente da inflama&#231;&#227;o em pacientes com psor&#237;ase&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> H&#225; algumas semelhan&#231;as nos mecanismos de privil&#233;gio imunol&#243;gico do fol&#237;culo piloso e do olho&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> As gl&#226;ndulas meibomianas fazem parte da rede de gl&#226;ndulas seb&#225;ceas da pele e&#44; portanto&#44; respondem &#224;s mesmas rea&#231;&#245;es inflamat&#243;rias que atuam na queda de cabelo&#46; Desse modo&#44; ter uma doen&#231;a no couro cabeludo&#44; como a psor&#237;ase ou o l&#237;quen plano pilar&#44; pode representar um risco para DGM e DOS&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> Por outro lado&#44; v&#225;rios estudos indicam uma associa&#231;&#227;o de DGM com doen&#231;as inflamat&#243;rias da superf&#237;cie ocular&#44; como a doen&#231;a de Sj&#246;gren&#44; e o epit&#233;lio conjuntival pode ser alvo direto do processo inflamat&#243;rio que leva &#224; infiltra&#231;&#227;o de linf&#243;citos na conjuntiva tarsal e&#44; al&#233;m disso&#44; o envolvimento direto das gl&#226;ndulas seb&#225;ceas ocorre em pacientes com l&#237;quen plano pilar&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">29&#44;30</span></a> De maneira similar&#44; esse envolvimento pode ser explicado por meio desse mecanismo na psor&#237;ase&#44; que &#233; doen&#231;a inflamat&#243;ria cr&#244;nica&#44; imunomediada por linf&#243;citos T e c&#233;lulas dendr&#237;ticas&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">O presente estudo tem algumas limita&#231;&#245;es&#46; Em primeiro lugar&#44; incluiu n&#250;mero relativamente pequeno de pacientes&#46; Em segundo lugar&#44; o m&#233;todo de meibografia mostra apenas altera&#231;&#245;es morfol&#243;gicas nas gl&#226;ndulas meibomianas&#59; portanto&#44; n&#227;o foram avaliadas altera&#231;&#245;es na qualidade da secre&#231;&#227;o meibomiana&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclus&#227;o</span><p id="par0130" class="elsevierStylePara elsevierViewall">De acordo com os resultados do presente estudo&#44; sugerimos que a psor&#237;ase pode afetar a morfologia da gl&#226;ndula meibomiana&#44; podendo causar altera&#231;&#245;es estruturais nas gl&#226;ndulas meibomianas e podendo determinar DGM e DOS&#46; A meibografia &#233; um m&#233;todo objetivo atual&#44; de abordagem n&#227;o invasiva&#44; amplamente preferido pelos m&#233;dicos para pacientes com doen&#231;as da gl&#226;ndula meibomiana e tem permitido a realiza&#231;&#227;o de muitos estudos sobre DGM&#46; O presente estudo &#233; o primeiro relato que avaliou a DGM em pacientes com psor&#237;ase utilizando a t&#233;cnica de meibografia e sua correla&#231;&#227;o positiva com a gravidade da doen&#231;a&#46; Por outro lado&#44; a literatura dermatol&#243;gica geralmente n&#227;o indica adequadamente essas complica&#231;&#245;es&#59; entretanto&#44; compreens&#227;o e manejo completos do envolvimento oft&#225;lmico s&#227;o importantes para o cuidado abrangente de pacientes com psor&#237;ase&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a> Portanto&#44; dermatologistas e oftalmologistas devem estar cientes da DGM e DOS&#44; as quais podem ser vistas em pacientes com psor&#237;ase&#46; No presente estudo&#44; 4 de 50 pacientes &#40;8&#37;&#41; apresentaram sintomas oculares&#46; Portanto&#44; considera&#8208;se que exames oftalmol&#243;gicos peri&#243;dicos devam ser realizados em pacientes com psor&#237;ase&#44; principalmente naqueles que apresentam escores elevados no PASI&#44; independente da presen&#231;a de sintomas oculares&#44; e que o diagn&#243;stico precoce da condi&#231;&#227;o d&#225; aos pacientes a chance de tratamento&#44; melhorando sua qualidade de vida&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Suporte financeiro</span><p id="par0140" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Contribui&#231;&#227;o dos autores</span><p id="par0150" class="elsevierStylePara elsevierViewall">Funda Kemeriz&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em cobduta proped&#234;utica e&#47;ou terap&#234;utica dos casos estudados&#59; revis&#227;o cr&#237;tica do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Burcu Tu&#287;rul&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Erdo&#287;an Ya&#351;ar&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em cobduta proped&#234;utica e&#47;ou terap&#234;utica dos casos estudados&#59; revis&#227;o cr&#237;tica do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; an&#225;lise estat&#237;stica&#59; concep&#231;&#227;o e planejamento do estudo&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflito de interesses</span><p id="par0165" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Estudos anteriores demonstraram que anormalidades nos testes do olho seco e disfun&#231;&#227;o da gl&#226;ndula meibomiana &#40;DGM&#41; podem ocorrer na psor&#237;ase&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">O objetivo do presente estudo foi avaliar a doen&#231;a do olho seco &#40;DOS&#41;&#44; DGM em pacientes com psor&#237;ase&#44; utilizando a meibografia&#44; que &#233; um m&#233;todo atual&#44; objetivo e n&#227;o invasivo para pacientes com doen&#231;as da gl&#226;ndula meibomiana&#44; a fim de investigar a rela&#231;&#227;o entre a gravidade da doen&#231;a e o envolvimento ocular&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Este estudo incluiu 50 participantes com psor&#237;ase e 50 indiv&#237;duos saud&#225;veis&#46; Todos os indiv&#237;duos foram examinados pelo mesmo dermatologista e encaminhados para exame oftalmol&#243;gico&#44; incluindo avalia&#231;&#227;o das altera&#231;&#245;es da margem das p&#225;lpebras&#44; obstru&#231;&#227;o da gl&#226;ndula meibomiana&#44; avalia&#231;&#227;o do &#237;ndice de doen&#231;a da superf&#237;cie ocular&#44; teste do tempo de ruptura do filme lacrimal&#44; teste de Schirmer e avalia&#231;&#227;o da conjuntiva e da c&#243;rnea na colora&#231;&#227;o com fluoresce&#237;na&#46; Al&#233;m disso&#44; as p&#225;lpebras superiores e inferiores foram avaliadas por meio da meibografia para perda da gl&#226;ndula meibomiana&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">DGM &#40;28&#37;&#41;&#44; perda da gl&#226;ndula meibomiana &#40;PGM&#41; &#40;29&#44;5&#37;&#41;&#44; escore superior na meibografia &#40;0&#44;61 &#177;<span class="elsevierStyleHsp" style=""></span>0&#44;81&#41;&#44; escore inferior na meibografia &#40;0&#44;46 &#177;<span class="elsevierStyleHsp" style=""></span>0&#44;61&#41; e DOS &#40;22&#37;&#41; foram significativamente maiores no grupo psor&#237;ase em compara&#231;&#227;o ao grupo controle &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;008&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;027&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;041&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;044&#44; respectivamente&#41;&#46; Houve rela&#231;&#227;o significativa entre DGM e &#205;ndice de &#193;rea e Gravidade da Psor&#237;ase &#40;PASI&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#44; <span class="elsevierStyleItalic">odds ratio</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;211&#41;&#46; Houve rela&#231;&#227;o positiva significativa entre PGM e o PASI &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#44; r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>608&#41; e dura&#231;&#227;o da psor&#237;ase &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#44; r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;547&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Grupo de estudo pequeno e incapacidade de detectar mudan&#231;as na qualidade da secre&#231;&#227;o meibomiana com a meibografia foram as limita&#231;&#245;es do estudo&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#245;es</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A psor&#237;ase pode afetar a morfologia da gl&#226;ndula meibomiana&#44; podendo causar altera&#231;&#245;es estruturais nas gl&#226;ndulas meibomianas&#44; e como consequ&#234;ncia&#44; pode determinar DGM e DOS&#46; Portanto&#44; oftalmologistas e dermatologistas devem estar atentos a essa situa&#231;&#227;o e coavaliar os pacientes em rela&#231;&#227;o a essas quest&#245;es&#46;</p></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Disfun&#231;&#227;o da gl&#226;ndula meibomiana&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;008&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Telangiectasia&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Altera&#231;&#245;es na jun&#231;&#227;o mucocut&#226;nea&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;044&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Perda de GM &#40;&#37;&#41; &#8211; mediana &#40;m&#237;n&#8208;m&#225;x&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#44;5 &#40;0&#8208;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;5 &#40;0&#8208;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Escore superior na meibografia &#8211; m&#233;dia &#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;61 &#177;<span class="elsevierStyleHsp" style=""></span>0&#44;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;30 &#177;<span class="elsevierStyleHsp" style=""></span>0&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;027&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Escore inferior na meibografia &#8211; m&#233;dia &#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;46 &#177;<span class="elsevierStyleHsp" style=""></span>0&#44;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;24 &#177;<span class="elsevierStyleHsp" style=""></span>0&#44;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;041&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Distor&#231;&#227;o da GM&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grupo psor&#237;ase&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grupo controle&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">OSDI &#8211; mediana &#40;m&#237;n&#46;&#8211;m&#225;x&#46;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11&#44;5 &#40;0&#8208;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7 &#40;0&#8208;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Tempo de ruptura do filme lacrimal &#40;s&#41; &#8211; mediana &#40;m&#237;n&#46;&#8211;m&#225;x&#46;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8 &#40;4&#8208;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;5 &#40;6&#8208;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Escore no teste de Schirmer &#40;mm&#41; &#8211; mediana &#40;m&#237;n&#46;&#8211;m&#225;x&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;5&#8208;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;4&#8208;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Escore de colora&#231;&#227;o &#8211; m&#233;dia &#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;52 &#177;<span class="elsevierStyleHsp" style=""></span>0&#44;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;24 &#177;<span class="elsevierStyleHsp" style=""></span>0&#44;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;038&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Doen&#231;a do olho seco&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;044&nbsp;\t\t\t\t\t\t\n
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Odds ratio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Odds ratio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Idade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;956&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;023&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;073&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Resultados do modelo de regress&#227;o log&#237;stica binomial para pacientes com psor&#237;ase</p>"
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                            0 => "E&#46; Viso"
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Artigo original
Avaliação da psoríase ocular com a técnica da meibografia
Funda Kemeriza,
Corresponding author
dr.fkmrz@hotmail.com

Autor para correspondência.
, Burcu Tugrulb, Erdogan Yasarc
a Departamento de Dermatologia, Aksaray University Faculty of Medicine, Aksaray, Turquia
b Departamento de Dermatologia, Health Science University Ankara Oncology Training and Research Hospital, Ankara, Turquia
c Departamento de Oftalmologia, Aksaray University Faculty of Medicine, Aksaray, Turquia
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s&#227;o gl&#226;ndulas seb&#225;ceas localizadas nas p&#225;lpebras&#44; respons&#225;veis pela secre&#231;&#227;o de lip&#237;deos que desempenham um papel importante na superf&#237;cie ocular&#44; evitando a evapora&#231;&#227;o das l&#225;grimas&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A disfun&#231;&#227;o da gl&#226;ndula meibomiana &#40;DGM&#41; &#233; doen&#231;a cr&#244;nica caracterizada por obstru&#231;&#227;o do ducto terminal e&#47;ou altera&#231;&#245;es quantitativo&#8208;qualitativas nas secre&#231;&#245;es&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> A preval&#234;ncia de DGM varia entre 3&#44;5 e 74&#44;5&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#44;11</span></a> Obstru&#231;&#227;o da GM&#44; as secre&#231;&#245;es meibomianas&#44; telangiectasias&#44; perda da gl&#226;ndula&#44; bem como combina&#231;&#227;o de alguns desses par&#226;metros foram usadas para diagnosticar a DGM&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">12&#44;13</span></a> Uma rela&#231;&#227;o significativa foi encontrada entre a psor&#237;ase e a DGM em estudos&#59; no entanto&#44; a meibografia n&#227;o foi utilizada nos estudos com psor&#237;ase&#44; embora essa abordagem n&#227;o invasiva agora seja amplamente preferida para uso cl&#237;nico e tenha possibilitado a realiza&#231;&#227;o de muitos estudos cl&#237;nicos sobre doen&#231;as da gl&#226;ndula meibomiana&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">14&#8211;16</span></a> Al&#233;m disso&#44; a meibografia permite uma observa&#231;&#227;o objetiva das gl&#226;ndulas meibomianas&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A DGM pode causar ou exacerbar os sintomas do olho seco&#59; 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do ingl&#234;s <span class="elsevierStyleItalic">Psoriasis Area and Severity Index</span>&#41;&#46; A gravidade da psor&#237;ase em placas foi classificada como doen&#231;a leve e moderada a grave&#46; A doen&#231;a leve foi definida como PASI &#8804; 10&#44; e a doen&#231;a moderada a grave foi agrupada como PASI &#62;<span class="elsevierStyleHsp" style=""></span>10&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> As caracter&#237;sticas demogr&#225;ficas e os escores m&#233;dios do PASI foram registrados e documentados&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Diagn&#243;stico e avalia&#231;&#227;o das doen&#231;as oculares</span><p id="par0045" class="elsevierStylePara elsevierViewall">Os exames e testes foram realizados sequencialmente da seguinte forma&#58; as p&#225;lpebras superiores e inferiores foram avaliadas com um microsc&#243;pio para presen&#231;a de obstru&#231;&#227;o&#44; telangiectasia&#44; margens irregulares da p&#225;lpebra &#40;chanfradura ou <span class="elsevierStyleItalic">notching</span>&#41; e deslocamento da jun&#231;&#227;o mucocut&#226;nea&#46; Ap&#243;s o exame&#44; foram realizados colora&#231;&#227;o da superf&#237;cie ocular com fluoresce&#237;na&#44; teste do tempo de ruptura do filme lacrimal &#40;BUT&#44; do ingl&#234;s <span class="elsevierStyleItalic">Break&#8208;Up Time</span>&#41;&#44; teste de Schirmer e meibografia&#46; Os resultados desses testes foram registrados&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Os crit&#233;rios diagn&#243;sticos recomendados pelo MGD Study Group no Jap&#227;o foram utilizados para o diagn&#243;stico da DGM&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> A DGM foi diagnosticada quando a GM estava oclu&#237;da e havia anormalidades nas margens da p&#225;lpebra&#46; O BG&#8208;4<span class="elsevierStyleHsp" style=""></span>M <span class="elsevierStyleItalic">Non&#8208;Contact System</span> foi utilizado na meibografia &#40;Sirius&#44; <span class="elsevierStyleItalic">Costruzione Strumenti Oftalmici</span>&#44; Firenze&#44; It&#225;lia&#41;&#46; A avalia&#231;&#227;o da GM foi realizada com o aux&#237;lio de imagens de infravermelho de um biomicrosc&#243;pio com l&#226;mpada de fenda e uma c&#226;mera de v&#237;deo&#46; A taxa de perda da gl&#226;ndula meibomiana &#40;PGM&#41; para a &#225;rea total das gl&#226;ndulas foi calculada utilizando&#8208;se um <span class="elsevierStyleItalic">software</span>&#46; Com esse <span class="elsevierStyleItalic">software</span>&#44; o examinador marcava a &#225;rea total e a perda de &#225;rea&#44; e o percentual da PGM era calculado pelo <span class="elsevierStyleItalic">software</span>&#46; PGM foi registrada como grau 0 &#40;sem perda da GM&#41;&#44; grau 1 &#40;0 a 1&#47;3<span class="elsevierStyleHsp" style=""></span>da GM total&#41;&#44; grau 2 &#40;1&#47;3 a 2&#47;3<span class="elsevierStyleHsp" style=""></span>da GM total&#41; e grau 3 &#40;&#62; 2&#47;3<span class="elsevierStyleHsp" style=""></span>da GM total&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> A classifica&#231;&#227;o da PGM foi realizada com cegamento&#44; pelo mesmo pesquisador&#46; A distor&#231;&#227;o da GM foi registrada como 0 &#40;&#60; 50&#37; de altera&#231;&#245;es&#41; ou 1 &#40;&#62; 50&#37; de altera&#231;&#245;es&#41;&#46; Os escores na meibografia e a distor&#231;&#227;o da GM para as p&#225;lpebras superiores e inferiores foram avaliados para o olho direito&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">O diagn&#243;stico da doen&#231;a do olho seco foi verificado utilizando&#8208;se os crit&#233;rios <span class="elsevierStyleItalic">Tear Film &#38; Ocular Surface Society Dry Eye Workshop II</span> &#40;TFOS DEWS II&#41; modificados&#58; o &#237;ndice de doen&#231;a da superf&#237;cie ocular &#40;OSDI&#44; do ingl&#234;s <span class="elsevierStyleItalic">ocular surface disease index</span>&#41; &#62;<span class="elsevierStyleHsp" style=""></span>13 mais um no teste BUT &#60;<span class="elsevierStyleHsp" style=""></span>10 s&#44; escore do teste de Schirmer &#60;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>mm ou colora&#231;&#227;o da c&#243;rnea e conjuntiva &#62;<span class="elsevierStyleHsp" style=""></span>0&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> O teste BUT&#44; teste de Schirmer e colora&#231;&#227;o da c&#243;rnea e conjuntiva foram realizados no olho direito&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">An&#225;lise estat&#237;stica</span><p id="par0060" class="elsevierStylePara elsevierViewall">A an&#225;lise estat&#237;stica foi realizada com o <span class="elsevierStyleItalic">software</span> SPSS&#44; vers&#227;o 23&#46;0 para Windows &#40;SPSS Inc&#46;&#44; Chicago&#44; IL&#44; EUA&#41;&#46; O teste de Shapiro&#8208;Wilk foi usado para avaliar se a distribui&#231;&#227;o dos dados num&#233;ricos era normal&#46; O teste <span class="elsevierStyleItalic">t</span> para amostras independentes &#40;para uma distribui&#231;&#227;o normal&#41; e o teste de Mann&#8208;Whitney &#40;distribui&#231;&#227;o n&#227;o normal&#41; foram utilizados para comparar as m&#233;dias das vari&#225;veis num&#233;ricas entre os dois grupos&#46; O teste de qui&#8208;quadrado foi usado para comparar as m&#233;dias das vari&#225;veis categ&#243;ricas entre os dois grupos&#46; A an&#225;lise de correla&#231;&#227;o de Spearman foi usada para determinar a rela&#231;&#227;o entre as vari&#225;veis num&#233;ricas que apresentavam distribui&#231;&#227;o normal&#46; An&#225;lises de regress&#227;o log&#237;stica bin&#225;ria foram aplicadas para calcular os <span class="elsevierStyleItalic">odds ratios</span> para as associa&#231;&#245;es entre as vari&#225;veis explicativas&#59; valores de p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 foram considerados estatisticamente significativos&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0065" class="elsevierStylePara elsevierViewall">Os pacientes com diagn&#243;stico de psor&#237;ase &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#41; neste estudo inclu&#237;ram 26 &#40;52&#37;&#41; mulheres e 24 &#40;48&#37;&#41; homens&#44; e a m&#233;dia de idade dos 50 pacientes era de 43&#44;4 &#177;<span class="elsevierStyleHsp" style=""></span>14&#44;1 &#40;varia&#231;&#227;o&#44; 18&#8208;65&#41; anos&#46; Al&#233;m disso&#44; 25 indiv&#237;duos &#40;50&#37;&#41; do grupo controle eram do sexo feminino e 25 &#40;50&#37;&#41; do sexo masculino&#46; A m&#233;dia de idade do grupo controle &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#41; era de 41&#44;2 &#177;<span class="elsevierStyleHsp" style=""></span>8&#44;1 &#40;varia&#231;&#227;o&#44; 21&#8208;65&#41; anos&#46; N&#227;o houve diferen&#231;as estatisticamente significativas na idade e sexo entre os dois grupos &#40;p &#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">De acordo com a anamnese cl&#237;nica&#44; 4 dos 50 pacientes &#40;8&#37;&#41; apresentavam sintomas oculares subjetivos&#44; como prurido&#44; sensa&#231;&#227;o de queima&#231;&#227;o e ard&#234;ncia&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">A frequ&#234;ncia de DGM foi de 28&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#41; no grupo com psor&#237;ase e 6&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41; no grupo controle &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;008&#41;&#46; Uma compara&#231;&#227;o da oclus&#227;o da gl&#226;ndula meibomiana&#44; telangiectasia&#44; deslocamento da jun&#231;&#227;o mucocut&#226;nea e irregularidade da margem da p&#225;lpebra &#40;chanfradura&#41; &#233; apresentada na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">A PGM era de 29&#44;5&#37; no grupo com psor&#237;ase e 9&#44;5&#37; no grupo controle &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; A compara&#231;&#227;o dos escores superior e inferior na meibografia &#233; mostrada na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46; N&#227;o foram detectadas diferen&#231;as na distor&#231;&#227;o da GM entre os grupos &#40;p &#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">A frequ&#234;ncia de DOS no grupo com psor&#237;ase era de 22&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41;&#44; enquanto no grupo controle era de 6&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;044&#41;&#46; A compara&#231;&#227;o do OSDI&#44; teste BUT&#44; teste de Schirmer e o escore na colora&#231;&#227;o da c&#243;rnea &#233; apresentada na <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">O teste de correla&#231;&#227;o de Spearman foi realizado entre PGM&#44; escores PASI e a dura&#231;&#227;o da psor&#237;ase&#46; Uma correla&#231;&#227;o significativa positiva foi encontrada entre os escores PGM e PASI &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;608&#41;&#44; bem como a dura&#231;&#227;o da psor&#237;ase &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;547&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">A rela&#231;&#227;o entre a DGM e idade&#44; sexo&#44; dura&#231;&#227;o da psor&#237;ase e escores PASI foi avaliada atrav&#233;s do teste de regress&#227;o log&#237;stica binomial&#46; Uma rela&#231;&#227;o significativa foi encontrada entre os escores DGM e PASI &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#44; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;211&#41;&#46; N&#227;o foi observada rela&#231;&#227;o significativa entre idade&#44; sexo e dura&#231;&#227;o da psor&#237;ase &#40;p &#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#59; <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">A rela&#231;&#227;o entre DOS e idade&#44; sexo&#44; dura&#231;&#227;o da psor&#237;ase e escores PASI foi avaliada atrav&#233;s do teste de regress&#227;o log&#237;stica binomial&#46; Foi encontrada uma rela&#231;&#227;o significativa entre DOS e idade &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;023&#44; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;073&#41;&#46; N&#227;o foi observada rela&#231;&#227;o significativa entre sexo&#44; tempo de psor&#237;ase e escores PASI &#40;p &#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#59; <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discuss&#227;o</span><p id="par0105" class="elsevierStylePara elsevierViewall">Nossos dados representam o primeiro relato sobre PGM&#44; DGM e DOS mais elevados em pacientes com psor&#237;ase do que na popula&#231;&#227;o saud&#225;vel com o uso da t&#233;cnica da meibografia e sua rela&#231;&#227;o positiva com a gravidade da doen&#231;a&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Em estudos anteriores sobre psor&#237;ase e DGM realizados sem meibografia&#44; de acordo com diferentes crit&#233;rios diagn&#243;sticos&#44; verificou&#8208;se uma alta taxa de DGM em pacientes com psor&#237;ase&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">14&#44;15</span></a> Zengin et al&#46; realizaram um estudo com 70 pacientes com psor&#237;ase&#44; e verificaram que os pacientes com psor&#237;ase apresentavam mais obstru&#231;&#227;o&#44; &#237;ndices de espessura e um volume normal de secre&#231;&#227;o da gl&#226;ndula meibomiana&#46; Eles declararam que um tipo obstrutivo de DGM pode resultar do aumento da renova&#231;&#227;o do epit&#233;lio que reveste o ducto da gl&#226;ndula meibomiana em pacientes com psor&#237;ase&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> Aragona et al&#46; realizaram um estudo com 66 pacientes com psor&#237;ase&#44; e verificaram deteriora&#231;&#227;o significativa nos testes de superf&#237;cie ocular&#44; como altera&#231;&#227;o da camada lip&#237;dica do filme lacrimal&#44; instabilidade do filme lacrimal&#44; les&#245;es epiteliais da c&#243;rnea e conjuntiva e leve metaplasia escamosa na citologia de <span class="elsevierStyleItalic">imprint</span> no grupo de pacientes comparados com os participantes saud&#225;veis&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> De acordo com os crit&#233;rios do MGD Study Group no Jap&#227;o&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> a frequ&#234;ncia de DGM no presente estudo foi significativamente maior&#44; afetando 28&#37; dos pacientes com psor&#237;ase&#44; o que foi consistente com a literatura&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Anormalidades no teste do olho seco em pacientes com psor&#237;ase foram demonstradas em v&#225;rios estudos&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">19&#8211;21</span></a> Ghalamkarpour et al&#46; realizaram um estudo com 200 pacientes psori&#225;sicos e 100 controles saud&#225;veis&#44; e verificaram que os valores m&#233;dios dos testes BUT e Schirmer em pacientes com psor&#237;ase foram significativamente menores do que nos controles&#44; e escores significativamente maiores do OSDI foram observados nos pacientes em compara&#231;&#227;o com os controles&#46; A doen&#231;a do olho seco foi observada com maior frequ&#234;ncia nos pacientes do que no grupo saud&#225;vel&#46; Eles sugeriram que a inflama&#231;&#227;o sist&#234;mica em pacientes com psor&#237;ase pode desempenhar um papel importante nas anormalidades do olho seco&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a> Demirci et al&#46; realizaram um estudo com 30 pacientes com psor&#237;ase e 30 controles&#44; e verificaram que os valores de osmolaridade lacrimal&#44; OSDI&#44; escores da escala de Oxford eram significativamente mais elevados e o escore no teste BUT foi significativamente menor no grupo de pacientes em compara&#231;&#227;o com o grupo controle saud&#225;vel&#46; Eles sugeriram que a psor&#237;ase pode afetar a osmolaridade da l&#225;grima e a fun&#231;&#227;o do filme lacrimal atrav&#233;s de processos inflamat&#243;rios&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> Em estudo de Santos da Cruz et al&#46;&#44; com 43 pacientes com psor&#237;ase e 86 controles&#44; verificou&#8208;se que os pacientes com psor&#237;ase tinham taxa estatisticamente maior de olho seco &#40;16&#44;28&#37;&#41;&#44; prov&#225;vel olho seco &#40;32&#44;56&#37;&#41; e blefarite &#40;16&#44;28&#37;&#41; e doen&#231;a da superf&#237;cie ocular e os testes de Rosa Bengala foram mais anormais em pacientes com psor&#237;ase&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> No presente estudo&#44; de acordo com os crit&#233;rios do TFOS DEWS II&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> a frequ&#234;ncia de DOS foi significativamente maior em 22&#37; dos pacientes com psor&#237;ase&#44; o que est&#225; de acordo com a literatura&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">O mecanismo pelo qual a psor&#237;ase induz a DGM ainda n&#227;o foi esclarecido&#46; A psor&#237;ase &#233; doen&#231;a inflamat&#243;ria cr&#244;nica da pele&#44; caracterizada por hiperprolifera&#231;&#227;o e hiperqueratiniza&#231;&#227;o epid&#233;rmicas&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> Uma grande quantidade de c&#233;lulas &#233; produzida nessa doen&#231;a&#59; essas altera&#231;&#245;es podem ocorrer nas gl&#226;ndulas meibomianas e resultar na obstru&#231;&#227;o das gl&#226;ndulas e na DGM&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">14&#44;15&#44;20&#44;21</span></a> A diminui&#231;&#227;o das secre&#231;&#245;es meibomianas devido &#224; DGM no grupo com psor&#237;ase pode ter resultado no aumento da evapora&#231;&#227;o da l&#225;grima&#46; Al&#233;m disso&#44; a DOS pode ter ocorrido em raz&#227;o do aumento da osmolaridade lacrimal decorrente da inflama&#231;&#227;o em pacientes com psor&#237;ase&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> H&#225; algumas semelhan&#231;as nos mecanismos de privil&#233;gio imunol&#243;gico do fol&#237;culo piloso e do olho&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> As gl&#226;ndulas meibomianas fazem parte da rede de gl&#226;ndulas seb&#225;ceas da pele e&#44; portanto&#44; respondem &#224;s mesmas rea&#231;&#245;es inflamat&#243;rias que atuam na queda de cabelo&#46; Desse modo&#44; ter uma doen&#231;a no couro cabeludo&#44; como a psor&#237;ase ou o l&#237;quen plano pilar&#44; pode representar um risco para DGM e DOS&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> Por outro lado&#44; v&#225;rios estudos indicam uma associa&#231;&#227;o de DGM com doen&#231;as inflamat&#243;rias da superf&#237;cie ocular&#44; como a doen&#231;a de Sj&#246;gren&#44; e o epit&#233;lio conjuntival pode ser alvo direto do processo inflamat&#243;rio que leva &#224; infiltra&#231;&#227;o de linf&#243;citos na conjuntiva tarsal e&#44; al&#233;m disso&#44; o envolvimento direto das gl&#226;ndulas seb&#225;ceas ocorre em pacientes com l&#237;quen plano pilar&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">29&#44;30</span></a> De maneira similar&#44; esse envolvimento pode ser explicado por meio desse mecanismo na psor&#237;ase&#44; que &#233; doen&#231;a inflamat&#243;ria cr&#244;nica&#44; imunomediada por linf&#243;citos T e c&#233;lulas dendr&#237;ticas&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">O presente estudo tem algumas limita&#231;&#245;es&#46; Em primeiro lugar&#44; incluiu n&#250;mero relativamente pequeno de pacientes&#46; Em segundo lugar&#44; o m&#233;todo de meibografia mostra apenas altera&#231;&#245;es morfol&#243;gicas nas gl&#226;ndulas meibomianas&#59; portanto&#44; n&#227;o foram avaliadas altera&#231;&#245;es na qualidade da secre&#231;&#227;o meibomiana&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclus&#227;o</span><p id="par0130" class="elsevierStylePara elsevierViewall">De acordo com os resultados do presente estudo&#44; sugerimos que a psor&#237;ase pode afetar a morfologia da gl&#226;ndula meibomiana&#44; podendo causar altera&#231;&#245;es estruturais nas gl&#226;ndulas meibomianas e podendo determinar DGM e DOS&#46; A meibografia &#233; um m&#233;todo objetivo atual&#44; de abordagem n&#227;o invasiva&#44; amplamente preferido pelos m&#233;dicos para pacientes com doen&#231;as da gl&#226;ndula meibomiana e tem permitido a realiza&#231;&#227;o de muitos estudos sobre DGM&#46; O presente estudo &#233; o primeiro relato que avaliou a DGM em pacientes com psor&#237;ase utilizando a t&#233;cnica de meibografia e sua correla&#231;&#227;o positiva com a gravidade da doen&#231;a&#46; Por outro lado&#44; a literatura dermatol&#243;gica geralmente n&#227;o indica adequadamente essas complica&#231;&#245;es&#59; entretanto&#44; compreens&#227;o e manejo completos do envolvimento oft&#225;lmico s&#227;o importantes para o cuidado abrangente de pacientes com psor&#237;ase&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a> Portanto&#44; dermatologistas e oftalmologistas devem estar cientes da DGM e DOS&#44; as quais podem ser vistas em pacientes com psor&#237;ase&#46; No presente estudo&#44; 4 de 50 pacientes &#40;8&#37;&#41; apresentaram sintomas oculares&#46; Portanto&#44; considera&#8208;se que exames oftalmol&#243;gicos peri&#243;dicos devam ser realizados em pacientes com psor&#237;ase&#44; principalmente naqueles que apresentam escores elevados no PASI&#44; independente da presen&#231;a de sintomas oculares&#44; e que o diagn&#243;stico precoce da condi&#231;&#227;o d&#225; aos pacientes a chance de tratamento&#44; melhorando sua qualidade de vida&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Suporte financeiro</span><p id="par0140" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Contribui&#231;&#227;o dos autores</span><p id="par0150" class="elsevierStylePara elsevierViewall">Funda Kemeriz&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em cobduta proped&#234;utica e&#47;ou terap&#234;utica dos casos estudados&#59; revis&#227;o cr&#237;tica do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Burcu Tu&#287;rul&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Erdo&#287;an Ya&#351;ar&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em cobduta proped&#234;utica e&#47;ou terap&#234;utica dos casos estudados&#59; revis&#227;o cr&#237;tica do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; an&#225;lise estat&#237;stica&#59; concep&#231;&#227;o e planejamento do estudo&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflito de interesses</span><p id="par0165" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Estudos anteriores demonstraram que anormalidades nos testes do olho seco e disfun&#231;&#227;o da gl&#226;ndula meibomiana &#40;DGM&#41; podem ocorrer na psor&#237;ase&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">O objetivo do presente estudo foi avaliar a doen&#231;a do olho seco &#40;DOS&#41;&#44; DGM em pacientes com psor&#237;ase&#44; utilizando a meibografia&#44; que &#233; um m&#233;todo atual&#44; objetivo e n&#227;o invasivo para pacientes com doen&#231;as da gl&#226;ndula meibomiana&#44; a fim de investigar a rela&#231;&#227;o entre a gravidade da doen&#231;a e o envolvimento ocular&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Este estudo incluiu 50 participantes com psor&#237;ase e 50 indiv&#237;duos saud&#225;veis&#46; Todos os indiv&#237;duos foram examinados pelo mesmo dermatologista e encaminhados para exame oftalmol&#243;gico&#44; incluindo avalia&#231;&#227;o das altera&#231;&#245;es da margem das p&#225;lpebras&#44; obstru&#231;&#227;o da gl&#226;ndula meibomiana&#44; avalia&#231;&#227;o do &#237;ndice de doen&#231;a da superf&#237;cie ocular&#44; teste do tempo de ruptura do filme lacrimal&#44; teste de Schirmer e avalia&#231;&#227;o da conjuntiva e da c&#243;rnea na colora&#231;&#227;o com fluoresce&#237;na&#46; Al&#233;m disso&#44; as p&#225;lpebras superiores e inferiores foram avaliadas por meio da meibografia para perda da gl&#226;ndula meibomiana&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">DGM &#40;28&#37;&#41;&#44; perda da gl&#226;ndula meibomiana &#40;PGM&#41; &#40;29&#44;5&#37;&#41;&#44; escore superior na meibografia &#40;0&#44;61 &#177;<span class="elsevierStyleHsp" style=""></span>0&#44;81&#41;&#44; escore inferior na meibografia &#40;0&#44;46 &#177;<span class="elsevierStyleHsp" style=""></span>0&#44;61&#41; e DOS &#40;22&#37;&#41; foram significativamente maiores no grupo psor&#237;ase em compara&#231;&#227;o ao grupo controle &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;008&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;027&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;041&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;044&#44; respectivamente&#41;&#46; Houve rela&#231;&#227;o significativa entre DGM e &#205;ndice de &#193;rea e Gravidade da Psor&#237;ase &#40;PASI&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#44; <span class="elsevierStyleItalic">odds ratio</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;211&#41;&#46; Houve rela&#231;&#227;o positiva significativa entre PGM e o PASI &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#44; r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>608&#41; e dura&#231;&#227;o da psor&#237;ase &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#44; r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;547&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Grupo de estudo pequeno e incapacidade de detectar mudan&#231;as na qualidade da secre&#231;&#227;o meibomiana com a meibografia foram as limita&#231;&#245;es do estudo&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#245;es</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A psor&#237;ase pode afetar a morfologia da gl&#226;ndula meibomiana&#44; podendo causar altera&#231;&#245;es estruturais nas gl&#226;ndulas meibomianas&#44; e como consequ&#234;ncia&#44; pode determinar DGM e DOS&#46; Portanto&#44; oftalmologistas e dermatologistas devem estar atentos a essa situa&#231;&#227;o e coavaliar os pacientes em rela&#231;&#227;o a essas quest&#245;es&#46;</p></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;008&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;044&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Perda de GM &#40;&#37;&#41; &#8211; mediana &#40;m&#237;n&#8208;m&#225;x&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#44;5 &#40;0&#8208;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;5 &#40;0&#8208;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Escore superior na meibografia &#8211; m&#233;dia &#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;61 &#177;<span class="elsevierStyleHsp" style=""></span>0&#44;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;30 &#177;<span class="elsevierStyleHsp" style=""></span>0&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;027&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Escore inferior na meibografia &#8211; m&#233;dia &#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;46 &#177;<span class="elsevierStyleHsp" style=""></span>0&#44;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;24 &#177;<span class="elsevierStyleHsp" style=""></span>0&#44;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;041&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Distor&#231;&#227;o da GM&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grupo psor&#237;ase&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grupo controle&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">OSDI &#8211; mediana &#40;m&#237;n&#46;&#8211;m&#225;x&#46;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11&#44;5 &#40;0&#8208;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;0&#8208;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Tempo de ruptura do filme lacrimal &#40;s&#41; &#8211; mediana &#40;m&#237;n&#46;&#8211;m&#225;x&#46;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;4&#8208;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;5 &#40;6&#8208;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Escore no teste de Schirmer &#40;mm&#41; &#8211; mediana &#40;m&#237;n&#46;&#8211;m&#225;x&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;5&#8208;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;4&#8208;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Escore de colora&#231;&#227;o &#8211; m&#233;dia &#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;52 &#177;<span class="elsevierStyleHsp" style=""></span>0&#44;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;24 &#177;<span class="elsevierStyleHsp" style=""></span>0&#44;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;038&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Doen&#231;a do olho seco&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;044&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Doen&#231;a do olho seco</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Odds ratio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Odds ratio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Idade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;956&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;023&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;073&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sexo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;169&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Resultados do modelo de regress&#227;o log&#237;stica binomial para pacientes com psor&#237;ase</p>"
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