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os melan&#243;citos s&#227;o destru&#237;dos pelas c&#233;lulas T&#44; que constituem um dos principais mediadores da resposta autoimune&#44; criando &#225;reas de despigmenta&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> Um membro da superfam&#237;lia de imunoglobulinas&#44; o gene do ant&#237;geno 4 associado ao linf&#243;cito T citot&#243;xico &#40;<span class="elsevierStyleItalic">CTLA4</span>&#41;&#44; encontrado no <span class="elsevierStyleItalic">locus</span> 2q33&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a> codifica um receptor&#8208;chave inibit&#243;rio cuja fun&#231;&#227;o &#233; a de um potente regulador negativo da resposta das c&#233;lulas T durante a fase de <span class="elsevierStyleItalic">priming</span> da resposta imune&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> Portanto&#44; o <span class="elsevierStyleItalic">CTLA4</span> tem sido associado a v&#225;rias doen&#231;as autoimunes&#44; como doen&#231;a autoimune da tireoide&#44; doen&#231;a de Graves&#44; tireoidite de Hashimoto&#44; diabetes tipo 1&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a> psor&#237;ase&#44;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> doen&#231;a de Beh&#231;et<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> e alopecia areata&#44; embora a associa&#231;&#227;o com esta &#250;ltima permane&#231;a controversa&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Duas variantes gen&#233;ticas do <span class="elsevierStyleItalic">CTLA4</span> foram associadas ao desenvolvimento do vitiligo&#58;<span class="elsevierStyleHsp" style=""></span>&#43;49A&#47;G &#40;rs231775&#41;&#44; uma varia&#231;&#227;o <span class="elsevierStyleItalic">missense</span> do &#233;xon 1 que leva &#224; substitui&#231;&#227;o de treonina por alanina no c&#243;don 17 &#40;T17A&#41;&#59; e CT60 A&#47;G &#40;rs3087243&#41;&#44; localizado a 236 pb <span class="elsevierStyleItalic">downstream</span> de <span class="elsevierStyleItalic">CTLA4</span> 3&#8217;&#8208;UTR&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> Entretanto&#44; essas variantes e sua associa&#231;&#227;o com o vitiligo variam amplamente e parecem ser fortemente dependentes da popula&#231;&#227;o analisada&#46; <a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#8211;12</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Assim&#44; o presente estudo avaliou se as variantes do gene <span class="elsevierStyleItalic">CTLA4</span><span class="elsevierStyleHsp" style=""></span>&#43;49 A&#47;G e CT60 A&#47;G est&#227;o associadas ao vitiligo em uma popula&#231;&#227;o mexicana&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Material e m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Amostra</span><p id="par0020" class="elsevierStylePara elsevierViewall">Pacientes com vitiligo e controles saud&#225;veis foram recrutados do Departamento de Dermatologia do Hospital Universit&#225;rio Dr&#46; Jos&#233; Eleuterio Gonzalez&#44; Universidad Aut&#243;noma de Nuevo Le&#243;n &#40;UANL&#59; Monterrey&#44; M&#233;xico&#41;&#46; Os indiv&#237;duos eram origin&#225;rios da regi&#227;o nordeste do M&#233;xico&#44; incluindo os estados de Coahuila&#44; Nuevo Le&#243;n&#44; San Luis Potos&#237;&#44; Tamaulipas e Zacatecas&#46; Um total de 116 pacientes com vitiligo &#40;62 mulheres e 54 homens&#59; m&#233;dia de idade de 43&#44;06 &#177; 16&#44;34 anos&#41; e 117 controles saud&#225;veis &#40;75 mulheres e 42 homens&#59; m&#233;dia de idade de 29&#44;01<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;67 anos&#41; foram inclu&#237;dos neste estudo&#46; Todos os pacientes foram avaliados por um dermatologista&#46; A atividade do vitiligo foi determinada pelo intervalo de tempo entre a manifesta&#231;&#227;o de novas &#225;reas despigmentadas &#40;vitiligo com estabilidade da les&#227;o<span class="elsevierStyleHsp" style=""></span>&#62;1 ano&#41; ou aumento das j&#225; existentes&#46; O presente estudo foi aprovado pelo Comit&#234; de &#201;tica e Pesquisa do Hospital Universit&#225;rio Dr&#46; Jos&#233; Eleuterio Gonzalez &#8211; UANL &#40;c&#243;digo DE08&#8208;008&#41;&#46; Todos os participantes forneceram seu consentimento informado&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Isolamento de DNA</span><p id="par0025" class="elsevierStylePara elsevierViewall">O DNA gen&#244;mico foi isolado do sangue venoso perif&#233;rico dos pacientes com vitiligo e controles&#46; As amostras foram centrifugadas e a camada leucoplaquet&#225;ria foi processada para isolamento do DNA seguindo o m&#233;todo de <span class="elsevierStyleItalic">salting&#8208;out</span> &#8211; com o <span class="elsevierStyleItalic">pellet</span> de DNA ressuspenso em Tris&#8208;EDTA &#40;Ph 7&#44;8&#41; &#224; concentra&#231;&#227;o final de 0&#44;1&#8208;1&#44;0<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;&#956;L&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Genotipagem das variantes de <span class="elsevierStyleItalic">CTLA4</span><span class="elsevierStyleHsp" style=""></span>&#43;49A&#47;G &#40;rs231775&#41; e CT60 &#40;rs3087243&#41;</span><p id="par0030" class="elsevierStylePara elsevierViewall">A frequ&#234;ncia al&#233;lica das variantes do gene <span class="elsevierStyleItalic">CTLA4</span> rs231775 e rs3087243 foi caracterizada por PCR&#8208;RFLP em termociclador MJ Mini PTC1148 &#40;Bio&#8208;Rad&#44; Hercules&#59; CA&#44; EUA&#41;&#46; Os <span class="elsevierStyleItalic">primers</span> de oligonucleot&#237;deos para <span class="elsevierStyleItalic">CTLA4</span> rs231775 &#40;5&#8217;&#8208;CCA CGG CTT CCT TTC TCG TA&#8208;3&#8217; e 5&#8217;&#8208;AGT CTC ACT CAC CTT TGC AG&#8208;3&#8217;&#41; e <span class="elsevierStyleItalic">CTLA4</span> rs3087243 &#40;5&#8217;&#8208;ATG AGT CAG CTT TGC ACC AGC CAT TAC&#8208;3&#8217; e 5&#8217;&#8208;GAG GTG AAG AAC CTG TGT TAA ACA GCA TG&#8208;3&#8217;&#41; foram obtidos com IDT &#40;IA&#59; EUA&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">De acordo com um protocolo publicado anteriormente&#44; as enzimas <span class="elsevierStyleItalic">Bbv</span>I e <span class="elsevierStyleItalic">Nla</span>III &#40;New England Biolabs&#44; MA&#59; EUA&#41; foram usadas na an&#225;lise de restri&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> Os fragmentos do <span class="elsevierStyleItalic">amplicon</span> foram resolvidos por eletroforese em gel de agarose a 2&#44;5&#37;&#44; corados com brometo de et&#237;dio e observados em um transiluminador UVP modelo 2UV High Performance &#40;Upland&#44; CA&#44; EUA&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">An&#225;lise estat&#237;stica</span><p id="par0040" class="elsevierStylePara elsevierViewall">O tamanho da amostra foi definido com base na incid&#234;ncia relatada de vitiligo no M&#233;xico &#40;4&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> Considerando um poder estat&#237;stico de 99&#44;0&#37; &#40;Z<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;33&#41;&#44; um m&#237;nimo de 84 indiv&#237;duos &#233; suficiente para an&#225;lise gen&#233;tica precisa&#46; O <span class="elsevierStyleItalic">software</span> SPSS v21&#46;0 para Windows &#40;IBM&#44; IL&#59; EUA&#41; e o programa estat&#237;stico Epi&#8208;INFO&#8482; 7 &#40;CDC&#44; EUA&#41; foram utilizados na an&#225;lise estat&#237;stica&#46; O teste de equil&#237;brio de Hardy&#8208;Weinberg foi obtido para os alelos usando teste de ajuste&#44; enquanto a depend&#234;ncia genot&#237;pica entre pacientes e controles foi determinada com teste de &#967;<span class="elsevierStyleSup">2</span>&#46; O OR foi calculado a partir de tabelas de conting&#234;ncia 2<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>2&#46; Um valor de p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 foi considerado significante para todos os testes&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Resultados</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Par&#226;metros cl&#237;nicos</span><p id="par0045" class="elsevierStylePara elsevierViewall">Os 116 pacientes com vitiligo inclu&#237;dos neste estudo foram classificados em quatro categorias de acordo com a apresenta&#231;&#227;o cl&#237;nica da doen&#231;a&#58; 101 &#40;87&#44;07&#37;&#41; vitiligo vulgar &#40;VV&#41;&#44; 12 &#40;10&#44;35&#37;&#41; vitiligo focal &#40;VF&#41;&#44; 2 &#40;1&#44;72&#37;&#41; vitiligo universal &#40;VU&#41; e 1 &#40;0&#44;86&#37;&#41; vitiligo segmentar &#40;VS&#59; <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46; A idade de in&#237;cio&#44; o aparecimento das les&#245;es cut&#226;neas ap&#243;s trauma &#40;fen&#244;meno de Ko&#235;bner&#41; e as comorbidades comuns s&#227;o apresentadas nas tabelas 1 e 2&#46; Aproximadamente 47&#37; dos pacientes tinham pelo menos um familiar com vitiligo&#59; a idade de in&#237;cio antecedeu os 30 anos para 58&#44;48&#37; dos pacientes&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Dos pacientes com vitiligo&#44; 21 &#40;18&#44;1&#37;&#41; tinham hist&#243;ria pessoal de altera&#231;&#245;es tireoidianas &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#59; hipotireoidismo foi a mais prevalente &#40;8&#44;6&#37;&#41;&#46; Entretanto&#44; diabetes <span class="elsevierStyleItalic">mellitus</span> tipo 2 &#40;DM2&#44; 8&#44;62&#37;&#41; e hipertens&#227;o arterial &#40;HTN&#44; 16&#44;38&#37;&#41; foram as comorbidades mais encontradas nesses pacientes&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Correla&#231;&#227;o entre variantes do gene <span class="elsevierStyleItalic">CTLA4</span> e vitiligo</span><p id="par0055" class="elsevierStylePara elsevierViewall">O estudo investigou se as variantes do gene <span class="elsevierStyleItalic">CTLA4</span><span class="elsevierStyleHsp" style=""></span>&#43;49A&#47;G &#40;rs231775&#41; e CT60 &#40;rs3087243&#41; estavam associadas ao vitiligo em amostra de pacientes e controles saud&#225;veis mexicanos&#46; Nenhum desvio do equil&#237;brio de Hardy&#8208;Weinberg foi detectado para qualquer um dos polimorfismos de <span class="elsevierStyleItalic">CTLA4</span> avaliados &#40;&#91;rs231775&#58; pacientes com vitiligo Pearson 0&#44;889&#44; raz&#227;o de verossimilhan&#231;a 0&#44;889 e teste exato de Fisher 1&#59; controles Pearson 0&#44;885&#44; raz&#227;o de verossimilhan&#231;a 0&#44;885 e teste exato de Fisher 1&#93;&#44; &#91;rs3087243&#58; pacientes com vitiligo Pearson 0&#44;837&#44; raz&#227;o de verossimilhan&#231;a 0&#44;837 e teste exato de Fisher 1&#59; controles Pearson 0&#44;721&#44; raz&#227;o de verossimilhan&#231;a 0&#44;721 e teste exato de Fisher 0&#44;85&#93;&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">A compara&#231;&#227;o dos gen&#243;tipos e&#47;ou frequ&#234;ncias al&#233;licas de <span class="elsevierStyleItalic">CTLA4</span><span class="elsevierStyleHsp" style=""></span>&#43;49A&#47;G &#40;rs231775&#41; e CT60 &#40;rs3087243&#41; entre a coorte de casos e controles revelou que o gen&#243;tipo AG heterozigoto &#40;rs231775 e rs3087243&#41; teve maior frequ&#234;ncia em toda a coorte&#59; entretanto&#44; n&#227;o foi observada correla&#231;&#227;o estat&#237;stica entre os polimorfismos avaliados e o risco de desenvolver vitiligo &#40;p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#59; <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46; Al&#233;m disso&#44; n&#227;o foi encontrada nenhuma associa&#231;&#227;o entre gen&#243;tipos e atividade do vitiligo&#44; hist&#243;ria familiar&#44; hist&#243;ria pessoal de doen&#231;as autoimunes ou sexo nos pacientes analisados &#40;p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#59; <a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discuss&#227;o</span><p id="par0065" class="elsevierStylePara elsevierViewall">O vitiligo &#233; uma doen&#231;a complexa&#44; na qual os melan&#243;citos s&#227;o destru&#237;dos progressiva e seletivamente&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> M&#250;ltiplos fatores internos e externos t&#234;m sido associados ao desenvolvimento do vitiligo&#44; incluindo altera&#231;&#245;es autoimunes&#44; fatores gen&#233;ticos&#44; trauma epid&#233;rmico&#44; estresse emocional e infec&#231;&#245;es&#44; entre outros fatores de risco&#44; que podem agir independentemente uns dos outros ou em combina&#231;&#227;o&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2&#44;15</span></a> Al&#233;m disso&#44; acredita&#8208;se que o vitiligo possa ter padr&#227;o de heran&#231;a n&#227;o mendeliana&#44; penetr&#226;ncia incompleta&#44; m&#250;ltiplos <span class="elsevierStyleItalic">loci</span> de suscetibilidade e heterogeneidade gen&#233;tica&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">O vitiligo tem sido associado a m&#250;ltiplas variantes gen&#233;ticas&#44; muitas das quais est&#227;o envolvidas nas vias da resposta imune&#44; principalmente em rela&#231;&#227;o &#224;s regi&#245;es g&#234;nicas de classe I e classe II do ant&#237;geno leucocit&#225;rio humano &#40;HLA&#44; do ingl&#234;s <span class="elsevierStyleItalic">human leukocyte antigen</span>&#41; do complexo principal de histocompatibilidade &#40;MHC&#44; do ingl&#234;s <span class="elsevierStyleItalic">major histocompatibility complex</span>&#41; e genes candidatos n&#227;o MHC&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> Em rela&#231;&#227;o a esses &#250;ltimos&#44; o gene <span class="elsevierStyleItalic">CTLA4</span> codifica um correceptor de c&#233;lulas T expresso por c&#233;lulas T CD4<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>e CD8<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#44; que est&#225; envolvido na ativa&#231;&#227;o de c&#233;lulas T&#59; al&#233;m disso&#44; esse correceptor &#233; um regulador negativo cr&#237;tico da resposta das c&#233;lulas T&#44; desempenhando assim papel de prote&#231;&#227;o essencial contra a autoimunidade&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a> A resposta autoimune mediada pelas c&#233;lulas T CD8<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#233; fundamental durante o processo de despigmenta&#231;&#227;o do vitiligo&#44; pois essas c&#233;lulas s&#227;o diretamente respons&#225;veis pela destrui&#231;&#227;o dos melan&#243;citos&#44; criando as &#225;reas de despigmenta&#231;&#227;o da pele t&#237;picas da doen&#231;a&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">A associa&#231;&#227;o entre as variantes do gene <span class="elsevierStyleItalic">CTLA4</span><span class="elsevierStyleHsp" style=""></span>&#43;49G&#47;A e CT60 e o desenvolvimento de diferentes doen&#231;as autoimunes foi sugerida anteriormente&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">19&#44;20</span></a> Entretanto&#44; os resultados foram inconsistentes em doen&#231;as dermatol&#243;gicas&#59; por exemplo&#44; em casos de psor&#237;ase&#44; sua participa&#231;&#227;o ou falta de influ&#234;ncia foi relatada&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> Uma condi&#231;&#227;o semelhante foi observada durante o desenvolvimento da alopecia areata &#40;AA&#41;&#44; na qual um estudo de associa&#231;&#227;o anterior prop&#244;s o envolvimento de polimorfismos do <span class="elsevierStyleItalic">CTLA4</span> como fator de risco em seu desenvolvimento em uma popula&#231;&#227;o europeia&#59;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> no entanto&#44; outro estudo revelou que esses polimorfismos eram irrelevantes para o desenvolvimento dessa doen&#231;a em uma popula&#231;&#227;o mexicana&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Na Am&#233;rica Latina&#44; as variantes gen&#233;ticas do <span class="elsevierStyleItalic">CTLA4</span> s&#243; foram correlacionadas com o desenvolvimento de obesidade no nordeste do Brasil&#44;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> diabetes <span class="elsevierStyleItalic">mellitus</span> tipo 1 no Chile&#44;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> desenvolvimento do inibidor do FVIII em pacientes com hemofilia tipo A &#40;HA&#41; na Argentina&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> leishmaniose cut&#226;nea difusa na Venezuela<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> e v&#237;rus da hepatite C<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> e artrite reumatoide no M&#233;xico&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Embora a participa&#231;&#227;o&#44; ou falta de influ&#234;ncia&#44; de ambos os polimorfismos gen&#233;ticos tenha sido relatada para o vitiligo&#44; um estudo de metan&#225;lise&#44; incluindo 1&#46;252 casos em quatro popula&#231;&#245;es europeias&#44; tr&#234;s asi&#225;ticas e duas turcas revelou que a variante do gene <span class="elsevierStyleItalic">CTLA4</span> CT60 A&#47;G confere suscetibilidade ao vitiligo apenas na popula&#231;&#227;o europeia&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Em estudos anteriores&#44; observamos o papel de variantes gen&#233;ticas do TNF&#8208;&#945;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a> e PTPN22 &#40;<a href="https://www.sciencedirect.com/science/article/pii/S0365059620300921">https&#58;&#47;&#47;www&#46;sciencedirect&#46;com&#47;science&#47;article&#47;pii&#47;S0365059620300921</a> &#8208; bib0195&#41;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a> como fatores de risco no desenvolvimento de formas ativas de vitiligo em popula&#231;&#227;o mexicana&#46; Ambos os genes est&#227;o relacionados com a regula&#231;&#227;o de mecanismos imunol&#243;gicos&#46; No entanto&#44; a influ&#234;ncia das variantes do gene <span class="elsevierStyleItalic">CTLA4</span> no desenvolvimento do vitiligo n&#227;o foi analisada em pacientes mexicanos&#46; Talvez sem surpresa&#44; este estudo n&#227;o mostrou diferen&#231;a significante na presen&#231;a dos polimorfismos rs231775 ou rs3087243 na correla&#231;&#227;o com o desenvolvimento de vitiligo&#44; sugerindo que essas variantes gen&#233;ticas n&#227;o constituem fator de risco para a doen&#231;a em popula&#231;&#227;o do nordeste mexicano&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclus&#227;o</span><p id="par0095" class="elsevierStylePara elsevierViewall">As variantes do gene <span class="elsevierStyleItalic">CTLA4</span> rs231775 e rs3087243 n&#227;o constituem fator de risco para o desenvolvimento de vitiligo na popula&#231;&#227;o do nordeste mexicano&#46; Al&#233;m disso&#44; essas variantes gen&#233;ticas n&#227;o t&#234;m correla&#231;&#227;o com a hist&#243;ria pessoal de doen&#231;as autoimunes&#44; hist&#243;ria familiar de vitiligo ou o sexo dos pacientes&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Suporte financeiro</span><p id="par0100" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Contribui&#231;&#227;o dos autores</span><p id="par0105" class="elsevierStylePara elsevierViewall">Mauricio Salinas&#8208;Santander&#58; Concep&#231;&#227;o&#44; desenho e planejamento do estudo&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; reda&#231;&#227;o do manuscrito&#59; revis&#227;o cr&#237;tica da literatura e revis&#227;o cr&#237;tica do manuscrito&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">V&#237;ctor Su&#225;rez&#8208;Valencia&#58; An&#225;lise e interpreta&#231;&#227;o dos dados&#59; reda&#231;&#227;o do manuscrito&#59; revis&#227;o cr&#237;tica da literatura e revis&#227;o cr&#237;tica do manuscrito&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Mayela del &#193;ngel&#8208;Mart&#237;nez&#58; Interpreta&#231;&#227;o dos dados&#59; reda&#231;&#227;o do manuscrito&#59; revis&#227;o cr&#237;tica da literatura e revis&#227;o cr&#237;tica do manuscrito&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">David Kubelis&#8208;Lopez&#58; Interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica do manuscrito&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Natalia Zapata&#8208;Salazar&#58; Interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica do manuscrito&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Jorge Ocampo&#8208;Garza&#58; Revis&#227;o cr&#237;tica do manuscrito&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Jorge Ocampo&#8208;Candiani&#58; Revis&#227;o cr&#237;tica do manuscrito&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflito de interesses</span><p id="par0140" 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">O vitiligo &#233; caracterizado por resposta autoimune direcionada aos melan&#243;citos&#44; resultando na despigmenta&#231;&#227;o da pele&#46; Existem v&#225;rios componentes gen&#233;ticos envolvidos no desenvolvimento do vitiligo&#44; dos quais v&#225;rios polimorfismos gen&#233;ticos s&#227;o atualmente considerados fatores de risco&#46; Por exemplo&#44; as variantes do gene do ant&#237;geno 4 associado ao linf&#243;cito T citot&#243;xico &#40;<span class="elsevierStyleItalic">CTLA4</span>&#41;<span class="elsevierStyleHsp" style=""></span>&#43;49A&#47;G &#40;rs231775&#41; e CT60 &#40;rs3087243&#41; foram associadas &#224; predisposi&#231;&#227;o para doen&#231;as autoimunes em diferentes popula&#231;&#245;es&#59; entretanto&#44; seu envolvimento no desenvolvimento do vitiligo permanece controverso&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar a associa&#231;&#227;o entre vitiligo e as variantes do gene <span class="elsevierStyleItalic">CTLA4</span><span class="elsevierStyleHsp" style=""></span>&#43;49A&#47;G &#40;rs231775&#41; e CT60 &#40;rs3087243&#41; em popula&#231;&#227;o mexicana&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">116 pacientes com vitiligo e 117 indiv&#237;duos controles do nordeste do M&#233;xico foram inclu&#237;dos no estudo&#44; com an&#225;lise por PCR&#8208;RFLP para determinar as variantes do gene <span class="elsevierStyleItalic">CTLA4</span><span class="elsevierStyleHsp" style=""></span>&#43;49A&#47;G &#40;rs231775&#41; e CT60 &#40;rs3087243&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">N&#227;o foi observada diferen&#231;a estat&#237;stica para ambos os polimorfismos g&#234;nicos entre pacientes com vitiligo e controles &#40;p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#41;&#46; Al&#233;m disso&#44; quando os par&#226;metros de atividade e hist&#243;ria familiar de vitiligo&#44; hist&#243;ria pessoal de doen&#231;as autoimunes ou sexo foram analisados&#44; n&#227;o foram observadas diferen&#231;as &#40;p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclus&#227;o</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Como sugerido pela an&#225;lise de uma popula&#231;&#227;o do nordeste mexicano&#44; as variantes do gene <span class="elsevierStyleItalic">CTLA4</span><span class="elsevierStyleHsp" style=""></span>&#43;49A&#47;G &#40;rs231775&#41; e CT60 &#40;rs3087243&#41; n&#227;o constituem fator de risco no desenvolvimento do vitiligo&#46;</p></span>"
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Salinas&#8208;Santander MA&#44; Su&#225;rez&#8208;Valencia VJ&#44; del &#193;ngel&#8208;Mart&#237;nez M&#44; Kubelis&#8208;Lopez DE&#44; Zapata&#8208;Salazar NA&#44; Ocampo&#8208;Garza JA&#44; et al&#46; Association between the <span class="elsevierStyleItalic">CTLA4</span><span class="elsevierStyleHsp" style=""></span>&#43;49A&#47;G &#40;rs231775&#41; and CT60 &#40;rs3087243&#41; gene variants with vitiligo&#58; Study on a Mexican population&#46; An Bras Dermatol&#46; 2022&#59;97&#58;710&#8211;5&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Trabalho realizado no Departamento de Dermatologia&#44; Dr&#46; Jos&#233; E&#46; Gonz&#225;lez University Hospital&#44; Universidad Aut&#243;noma de Nuevo Le&#243;n&#44; Monterrey&#44; M&#233;xico&#46;</p>"
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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-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t" scope="col">Tipo de vitiligo&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\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">Fen&#244;meno de Ko&#235;bner&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\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">Idade de in&#237;cio</th></tr><tr title="table-row"><th class="td" title="\n
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                  \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">Feminino&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">Masculino&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">Ativo&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">Est&#225;vel&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="" 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">Antes dos 30 anos&#44; n&#160;&#40;&#37;&#41;&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">Ap&#243;s os 30 anos&#44;n&#160;&#40;&#37;&#41;&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vitiligo vulgar &#40;VV&#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">56 &#40;48&#44;28&#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">45 &#40;38&#44;79&#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">45 &#40;38&#44;79&#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">56 &#40;48&#44;28&#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">32 &#40;27&#44;59&#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">61 &#40;52&#44;59&#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">40 &#40;34&#44;48&#37;&#41;&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">Vitiligo universal &#40;VU&#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">1 &#40;0&#44;86&#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">1 &#40;0&#44;86&#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">&#8208;&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">2 &#40;1&#44;72&#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">&#8208;&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 &#40;0&#44;86&#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">1 &#40;0&#44;86&#37;&#41;&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">Vitiligo focal &#40;VF&#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">4 &#40;3&#44;45&#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">8 &#40;6&#44;90&#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">3 &#40;2&#44;59&#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;7&#44;76&#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">2 &#40;1&#44;72&#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">6 &#40;5&#44;17&#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">6 &#40;5&#44;17&#37;&#41;&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">Vitiligo segmentar &#40;VS&#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">1 &#40;0&#44;86&#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">&#8208;&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 &#40;0&#44;86&#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">&#8208;&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">&#8208;&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 &#40;0&#44;86&#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">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3688196.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Par&#226;metros cl&#237;nicos dos pacientes com vitiligo</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Tabela 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">AA&#44; alopecia areata&#59; DM2&#44; diabetes mellitus tipo 2&#59; HTN&#44; hipertens&#227;o arterial&#59; VV&#44; vitiligo vulgar&#59; VU&#44; vitiligo universal&#59; VF&#44; vitiligo focal&#59; VS&#44; vitiligo segmentar&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                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
                  \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
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Doen&#231;as autoimunes&#44; n &#40;&#37;&#41;</th><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></tr><tr title="table-row"><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">Tipo de Vitiligo&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">Tireoide&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">AA&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">DM2&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">HTN&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">Atopia&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vulgar &#40;VV&#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">19 &#40;16&#44;38&#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;2&#44;59&#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">10 &#40;8&#44;62&#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">18 &#40;15&#44;52&#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;2&#44;59&#41;&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">Universal &#40;VU&#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">&#8208;&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">&#8208;&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">&#8208;&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">&#8208;&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 &#40;0&#44;86&#41;&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">Focal &#40;VF&#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">2 &#40;1&#44;72&#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">1 &#40;0&#44;86&#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">&#8208;&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 &#40;0&#44;86&#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">&#8208;&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">Segmentar &#40;VS&#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">&#8208;&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">&#8208;&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">&#8208;&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">&#8208;&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 &#40;0&#44;86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab3688199.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Doen&#231;as autoimunes associadas ao vitiligo</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabela 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
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            0 => array:2 [
              "tabla" => array:1 [
                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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gen&#243;tipo&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">Vitiligo&#44; n &#40;&#37;&#41;&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">Controle&#44; n &#40;&#37;&#41;&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">&#967;<span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span>&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">OR&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">IC95&#37;&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&#8208;valor&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Todos os tipos de vitiligo&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">rs231775&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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">AA&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">42 &#40;36&#44;2&#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">33 &#40;28&#44;2&#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">2&#44;034&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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;362&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">AG&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">55 &#40;47&#44;4&#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">59 &#40;50&#44;4&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GG&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">19 &#40;16&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>GG&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">55 &#40;47&#44;4&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>19 &#40;16&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">59 &#40;50&#44;4&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>25 &#40;21&#44;4&#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\ttop\n
                  \t\t\t\t">Alelos&nbsp;\t\t\t\t\t\t\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">A&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Vitiligo ativo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">AG&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18 &#40;36&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">59 &#40;50&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">GG&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>GG&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">18 &#40;36&#44;7&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>11 &#40;22&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">59 &#40;50&#44;4&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>25 &#40;21&#44;4&#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">0&#44;874&#8208;3&#44;527&nbsp;\t\t\t\t\t\t\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">A&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Vitiligo est&#225;vel&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">GG&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">AG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>GG&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">37 &#40;55&#44;2&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>8 &#40;12&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">59 &#40;50&#44;4&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>25 &#40;21&#44;4&#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">Alelos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">81 &#40;60&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">125 &#40;53&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;866&#8208;2&#44;051&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;191&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">G&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">GG&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">AG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>GG&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">59 &#40;50&#44;4&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>25 &#40;21&#44;4&#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">Alelos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Todos os tipos de vitiligo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;475&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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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">AG&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">59 &#40;50&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">59 &#40;50&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GG&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">31&#40;26&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">38 &#40;32&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>GG&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">59 &#40;50&#44;9&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>31 &#40;26&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">59 &#40;50&#44;4&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>38 &#40;32&#44;5&#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">0&#44;732&#8208;2&#44;683&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alelos&nbsp;\t\t\t\t\t\t\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">A&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">99 &#40;42&#44;3&#41;&nbsp;\t\t\t\t\t\t\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">G&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">121 &#40;52&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">135 &#40;57&#44;7&#41;&nbsp;\t\t\t\t\t\t\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">Vitiligo ativo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">AA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;26&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 &#40;17&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;369&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AG&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">21 &#40;42&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">59 &#40;50&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GG&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;30&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">38 &#40;32&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \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">AG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>GG&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">21 &#40;42&#44;9&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>15 &#40;30&#44;6&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59 &#40;50&#44;4&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>38 &#40;32&#44;5&#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\ttop\n
                  \t\t\t\t">1&#44;931&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;790&#8208;3&#44;883&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;165&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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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alelos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&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">47 &#40;48&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">99 &#40;42&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;344&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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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">G&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">51 &#40;52&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">135 &#40;57&#44;7&#41;&nbsp;\t\t\t\t\t\t\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">Vitiligo est&#225;vel&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">AA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;19&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 &#40;17&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;469&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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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AG&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">38 &#40;56&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">59 &#40;50&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GG&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16 &#40;23&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">38 &#40;32&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>GG&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">38 &#40;56&#44;7&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>16 &#40;23&#44;9&#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">59 &#40;50&#44;4&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>38 &#40;32&#44;5&#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 ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alelos&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 ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&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\ttop\n
                  \t\t\t\t">64 &#40;47&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3688198.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Frequ&#234;ncias al&#233;licas e genot&#237;picas das variantes do gene <span class="elsevierStyleItalic">CTLA4</span><span class="elsevierStyleHsp" style=""></span>&#43;49A&#47;G &#40;rs231775&#41; e CT60 &#40;rs3087243&#41; em pacientes com vitiligo e controles saud&#225;veis</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Tabela 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AG&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ativo&nbsp;\t\t\t\t\t\t\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 ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Hist&#243;ria pessoal de doen&#231;as autoimunes</span>&nbsp;\t\t\t\t\t\t\n
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          "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Correla&#231;&#227;o entre os polimorfismos do gene <span class="elsevierStyleItalic">CTLA4</span><span class="elsevierStyleHsp" style=""></span>&#43;49A&#47;G &#40;rs231775&#41; e CT60 &#40;rs3087243&#41; com a atividade de vitiligo&#44; hist&#243;ria familiar&#44; hist&#243;ria pessoal de doen&#231;as autoimunes e sexo</p>"
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                            3 => "I&#46; Hamzavi"
                            4 => "J&#46;E&#46; Harris"
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                        "tituloSerie" => "Vitiligo&#46; Nat Rev Dis Primers"
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                            3 => "H&#46;G&#46; Martinez-Rodriguez"
                            4 => "D&#46;E&#46; Kubelis-Lopez"
                            5 => "N&#46;A&#46; Zapata-Salazar"
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                            4 => "R&#46; Kuromaru"
                            5 => "N&#46; Matsuura"
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