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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">Epiderm&#243;lise bolhosa &#40;EB&#41; &#233; um grupo de doen&#231;as heredit&#225;rias raras&#44; at&#233; o momento incur&#225;veis&#44; geneticamente determinadas&#44; caracterizadas por fragilidade da pele e mucosas&#46; H&#225; forma&#231;&#227;o de bolhas mucocut&#226;neas&#44; eros&#245;es e ulcera&#231;&#245;es a pequenos traumas&#44; o que causa impacto na qualidade de vida dos indiv&#237;duos acometidos&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">O consenso para classifica&#231;&#227;o das EB de 2020<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a> separou as formas cl&#225;ssicas de EB de outras doen&#231;as que cursam com fragilidade cut&#226;nea&#44; em que a clivagem na pele &#233; muito superficial &#40;suprabasal&#41;&#44; como s&#237;ndrome da pele dec&#237;dua&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a> Nas formas cl&#225;ssicas de EB&#44; o quadro cl&#237;nico &#233; heterog&#234;neo&#46; De acordo com o plano de clivagem na pele&#44; as EB s&#227;o divididas em quatro tipos principais&#58; EB simples &#40;EBS&#41;&#44; EB juncional &#40;EBJ&#41;&#44; EB Ddistr&#243;fica &#40;EBD&#41; e EB Kindler &#40;EBK&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a> Mais de 30 subtipos cl&#237;nicos s&#227;o reconhecidos e foram descritas muta&#231;&#245;es patog&#234;nicas em 21 genes distintos&#44; que codificam prote&#237;nas envolvidas na ades&#227;o e integridade celulares&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Dados epidemiol&#243;gicos no Brasil sobre EB s&#227;o escassos&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">3&#44;4</span></a> A associa&#231;&#227;o DEBRA Brasil tem registro de 1&#46;027 pacientes no pa&#237;s&#59; entretanto&#44; esse dado n&#227;o est&#225; publicado&#46; Os estudos brasileiros publicados s&#227;o relatos e s&#233;ries de casos com caracteriza&#231;&#227;o cl&#237;nica e alguns com an&#225;lise gen&#233;tica&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">3&#8211;13</span></a>Em doen&#231;as raras&#44; dados epidemiol&#243;gicos confi&#225;veis&#44; com base em coortes bem caracterizadas&#44; s&#227;o essenciais&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">14</span></a> Ressaltam a necessidade de aten&#231;&#227;o ao cuidado e aos custos para os sistemas de sa&#250;de de um pa&#237;s espec&#237;fico&#46; Tamb&#233;m s&#227;o importantes para o desenvolvimento e execu&#231;&#227;o de estudos cl&#237;nicos e para estimar o n&#250;mero de pacientes que poderiam se beneficiar com determinado tratamento&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a> Estudos cl&#237;nicos de fase 3 com Beremagene Geperpavec &#40;B&#8208;VEC&#41; em pacientes com EBD mostraram resultados promissores quanto &#224; cicatriza&#231;&#227;o de feridas&#46; Trata&#8208;se de terapia t&#243;pica gen&#233;tica associada &#224; edi&#231;&#227;o g&#234;nica&#44; com sequ&#234;ncias de COL7A1 encapsuladas em vetores virais de herpes simples tipo 1&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">O objetivo desse estudo foi descrever os achados cl&#237;nicos e epidemiol&#243;gicos da EB heredit&#225;ria de um hospital terci&#225;rio em S&#227;o Paulo&#44; Brasil&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Estudo observacional&#44; retrospectivo e transversal foi conduzido&#44; ap&#243;s aprova&#231;&#227;o do Comit&#234; de &#201;tica da institui&#231;&#227;o&#44; por meio da an&#225;lise de prontu&#225;rios f&#237;sicos e eletr&#244;nicos de 309 pacientes diagnosticados com EB&#44; na Divis&#227;o de Dermatologia do Hospital das Cl&#237;nicas da Faculdade de Medicina da Universidade de S&#227;o Paulo &#40;HC&#8208;FMUSP&#41;&#44; Brasil&#44; de 1 de janeiro de 2000 a 31 de dezembro de 2022&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">O diagn&#243;stico foi baseado na apresenta&#231;&#227;o cl&#237;nica&#44; hist&#243;ria familiar&#44; comorbidades e nos exames histol&#243;gico e de imunomapeamento obtidos por meio de material de biopsia de pele&#46; Os diagn&#243;sticos foram agrupados nas seguintes categorias&#58; EBS&#44; EBJ&#44; EBD dominante &#40;EBDD&#41;&#44; EBD recessiva &#40;EBDR&#41;&#44; EBD pruriginosa e EBK&#46; Pacientes com dados incompletos ou prontu&#225;rios m&#233;dicos indispon&#237;veis foram exclu&#237;dos&#44; assim como as doen&#231;as com clivagem suprabasal &#40;consenso de 2020&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a> Indiv&#237;duos com a doen&#231;a e familiares tamb&#233;m acometidos que n&#227;o estavam registrados no nosso servi&#231;o n&#227;o foram ativamente recrutados&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">O banco de dados utilizado nesse estudo incluiu forma cl&#237;nica de EB&#44; sexo&#44; hist&#243;ria familiar de EB&#44; presen&#231;a de consanguinidade&#44; idade de diagn&#243;stico&#44; idade atual&#44; tempo de seguimento&#44; comorbidades&#44; realiza&#231;&#227;o de exame histol&#243;gico e de imunomapeamento&#44; presen&#231;a de nevos EB e de tumores cut&#226;neos&#44; causa e idade de morte &#40;se aplic&#225;vel&#41;&#46; Teste gen&#233;tico n&#227;o foi inclu&#237;do&#44; pois n&#227;o &#233; ainda rotineiramente dispon&#237;vel no servi&#231;o&#46; Dados estat&#237;sticos foram apresentados como porcentagens e m&#233;dias&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0040" class="elsevierStylePara elsevierViewall">No total&#44; dos 309 pacientes com EB&#44; 31 foram exclu&#237;dos&#44; devido a dados incompletos&#46; No total de&#160;278&#160;pacientes inclu&#237;dos&#44; 147 &#40;53&#37;&#41; eram mulheres e 131 &#40;47&#37;&#41;&#44; homens&#46; O tipo mais comum foi a forma distr&#243;fica&#44; com 203 pacientes &#40;73&#37;&#41;&#44; dentre os quais 79 &#40;28&#44;4&#37;&#41; s&#227;o EBDD &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1A</a>&#41;&#44; 36 &#40;12&#44;9&#37;&#41; s&#227;o EBD pruriginosa &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1B</a>&#41; e 88 &#40;31&#44;7&#37;&#41; s&#227;o EBDR &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; Outros tipos foram EBJ &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41; com 26 &#40;9&#44;4&#37;&#41; pacientes&#44; EBS &#40;<a class="elsevierStyleCrossRef" href="#fig0020">fig&#46; 4</a>&#41; com 46 &#40;16&#44;5&#37;&#41; e tipo Kindler &#40;<a class="elsevierStyleCrossRef" href="#fig0025">fig&#46; 5</a>&#41; em 3 &#40;1&#44;1&#37;&#41;&#46; Hist&#243;ria familiar positiva foi encontrada em 96 &#40;35&#37;&#41; pacientes&#46; Relato de consanguinidade esteve presente em 31 &#40;11&#37;&#41; pacientes&#46; A distribui&#231;&#227;o dos pacientes pelo tipo de EB em rela&#231;&#227;o ao sexo&#44; ao hist&#243;rico familiar e &#224; consanguinidade pode ser observada na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">A m&#233;dia de idade ao diagn&#243;stico foi de 10&#44;8 anos &#40;variou de 1 dia de vida at&#233; 82 anos&#44; conforme detalhado na <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46; Noventa e tr&#234;s &#40;33&#44;5&#37;&#41; pacientes foram diagnosticados com menos de 1 ano de vida&#44; enquanto 103 &#40;37&#37;&#41; tinham entre 1 e 10 anos&#46; Entre 11 e 20 anos de idade&#44; 29 &#40;10&#37;&#41; pacientes foram diagnosticados&#46; Entre 21 e 80 anos&#44; 52 &#40;19&#37;&#41; pacientes obtiveram diagn&#243;stico de EB&#44; enquanto somente um paciente masculino tinha 82 anos&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Em rela&#231;&#227;o &#224; idade atual &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#44; a m&#233;dia foi de 26 anos&#46; Para o c&#225;lculo&#44; a idade considerada no caso dos pacientes que foram &#224; &#243;bito foi a idade da morte&#46; Somente 40 &#40;14&#37;&#41; indiv&#237;duos tinham menos de 10 anos&#44; enquanto 92 &#40;33&#37;&#41; pacientes tinham entre 11 e 20 anos&#46; Na faixa et&#225;ria entre 21 e 80 anos&#44; havia 143 &#40;51&#37;&#41; pacientes&#44; enquanto tr&#234;s tinham mais de 81 anos&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">A m&#233;dia do tempo de seguimento foi de 9 anos&#44; exclu&#237;dos seis pacientes que compareceram somente para exame diagn&#243;stico e n&#227;o compareceram para seguimento no ambulat&#243;rio&#46; Para os pacientes falecidos&#44; foi considerada a data da &#250;ltima consulta antes de o &#243;bito acontecer&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Em rela&#231;&#227;o ao comprometimento extracut&#226;neo &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#44; 40 &#40;14&#37;&#41; pacientes tiveram diferentes graus de disfagia &#40;estenose de es&#244;fago&#41;&#46; Desses&#44; 25 &#40;62&#44;5&#37;&#41; s&#227;o EBDR&#44; 10 &#40;25&#37;&#41; s&#227;o EBDD&#44; dois &#40;5&#37;&#41; s&#227;o EBD pruriginosa&#44; dois &#40;5&#37;&#41; s&#227;o EBJ&#44; um &#40;2&#44;5&#37;&#41; &#233; EBS e nenhum &#233; EBK&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Doen&#231;as dent&#225;rias foram identificadas em 100 &#40;36&#37;&#41; pacientes&#44; dentre os quais 54 &#40;54&#37;&#41; s&#227;o EBDR&#44; 28 &#40;28&#37;&#41; s&#227;o EBDD&#44; 13 &#40;13&#37;&#41; s&#227;o EBS&#44; tr&#234;s &#40;3&#37;&#41; s&#227;o EBJ&#44; dois &#40;2&#37;&#41; s&#227;o EBK e nenhum &#233; EBD pruriginosa&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Desnutri&#231;&#227;o foi avaliada por meio do &#237;ndice de massa corporal &#40;IMC &#8804; 18&#41; e acometeu 35 &#40;13&#37;&#41; indiv&#237;duos&#46; Desses&#44; 24 &#40;68&#44;6&#37;&#41; s&#227;o EBDR&#44; seis &#40;17&#44;1&#37;&#41; s&#227;o EBDD&#44; tr&#234;s &#40;8&#44;5&#37;&#41; s&#227;o EBS&#44; um &#40;2&#44;9&#37;&#41; &#233; EBJ e um &#40;2&#44;9&#37;&#41; &#233; EBK&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Anemia foi achado frequente&#44; com 81 &#40;29&#37;&#41; pacientes acometidos&#59; seis &#40;2&#37;&#41; deles foram submetidos a transfus&#245;es sangu&#237;neas&#44; todos EBDR&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Acometimento ortop&#233;dico foi observado em 67&#160;&#40;24&#37;&#41; pacientes e aqueles com pseudosindactilia nas m&#227;os &#40;59 pacientes&#41; foram encaminhados ao ambulat&#243;rio de ortopedia&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Nevos da epiderm&#243;lise bolhosa &#40;nevos EB&#41; foram identificados em 47 &#40;17&#37;&#41; indiv&#237;duos&#44; no total de 90 nevos&#44; uma vez que um mesmo paciente apresentou de uma a cinco les&#245;es &#40;<a class="elsevierStyleCrossRef" href="#fig0030">fig&#46; 6A</a>&#41;&#46; Dez pacientes eram EBDD&#44; 29 eram EBDR&#44; dois eram EBJ&#44; cinco eram EBS e um era EBD pruriginosa&#46;</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Atresia de piloro foi identificada em uma paciente EBS com acometimento cut&#226;neo grave&#46; Distrofia muscular foi observada em um paciente EBS&#46; Cardiomiopatia dilatada foi identificada em um paciente EBK de 30 anos que perdeu seguimento e em um paciente EBDR&#44; que foi a &#243;bito aos 20 anos&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Altera&#231;&#245;es dermatol&#243;gicas n&#227;o relacionadas &#224; EB incluem dermatite seborreica &#40;1&#41;&#44; dermatite at&#243;pica &#40;1&#41;&#44; pseudot&#237;nea amiant&#225;cea &#40;1&#41;&#46; Foliculite decalvante foi identificada em dois indiv&#237;duos&#44; ambos com a forma distr&#243;fica de EB&#46; Alopecia cicatricial acometeu duas pacientes EBJ&#46; A <a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a> mostra outras doen&#231;as extracut&#226;neas encontradas nos pacientes dessa coorte&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">No processo de investiga&#231;&#227;o diagn&#243;stica&#44; 202 &#40;72&#44;6&#37;&#41; indiv&#237;duos foram submetidos ao total de 302 biopsias para exame histol&#243;gico&#46; Imunomapeamento foi realizado em 256 &#40;92&#37;&#41; pacientes&#44; com total de 359 exames realizados nesse per&#237;odo&#46; Nove realizaram somente biopsia&#44; 63 realizaram somente imunomapeamento&#44; 193 pacientes foram submetidos a ambos os exames e 13 n&#227;o fizeram nenhum&#46; A classifica&#231;&#227;o do tipo de EB dos 13 pacientes que n&#227;o realizaram nenhum exame levou em considera&#231;&#227;o hist&#243;ria familiar e quadro cl&#237;nico compat&#237;vel&#44; apesar de o diagn&#243;stico n&#227;o ter sido confirmado laboratorialmente&#46; Esses pacientes n&#227;o foram submetidos &#224; biopsia de pele ou imunomapeamento por quest&#245;es sociais &#40;indisponibilidade de retornar ao hospital&#41; ou por falta de consentimento dos respons&#225;veis ou dos pr&#243;prios pacientes &#40;cinco rec&#233;m&#8208;natos&#44; cinco crian&#231;as menores de 12 anos e tr&#234;s adultos&#44; idades 17&#44; 27 e 49 anos&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Durante o per&#237;odo de seguimento&#44; nove &#40;3&#44;2&#37;&#41; pacientes foram diagnosticados com 11 carcinomas espinocelulares &#40;CEC&#41;&#46; Um paciente EBJ apresentou tr&#234;s CEC &#40;um em cada membro inferior e um no dorso&#41;&#46; A localiza&#231;&#227;o do CEC &#40;<a class="elsevierStyleCrossRef" href="#fig0030">fig&#46; 6B</a>&#41; nos demais pacientes foi nos membros inferiores em seis &#40;um EBJ&#44; quatro EBDR e um EBDD&#41; e dorso em um paciente &#40;EBDR&#41;&#46; Em uma das pacientes EBDR&#44; o local do CEC &#233; desconhecido&#44; por falta de informa&#231;&#227;o nos registros m&#233;dicos&#46; Amputa&#231;&#227;o transtibial foi realizada em tr&#234;s pacientes &#40;dois homens EBDR aos 18 e aos 19 anos e uma mulher EBDD aos 27 anos&#41;&#46; Cinco &#40;55&#44;5&#37;&#41; apresentaram met&#225;stase e foram a &#243;bito&#44; dentre os quais tr&#234;s EBDR &#40;a idade do &#243;bito de dois foi aos 18 anos e de um foi aos 20 anos&#41;&#44; um EBDD &#40;28 anos&#41; e um EBJ &#40;57 anos&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">No total&#44; 11 pacientes foram a &#243;bito&#44; cinco EBDR &#40;18&#44; 18&#44; 20&#44; 22 e 24 anos&#41;&#44; cinco EBDD &#40;1&#44; 11&#44; 15&#44; 15&#44; 28 anos&#41; e um EBJ &#40;57 anos&#41;&#46; Causa de morte de cinco destes foi por complica&#231;&#245;es de CEC metast&#225;tico&#46; Tr&#234;s foram a &#243;bito em virtude de sepse por broncopneumonia &#40;dois EBDD&#44; ambos com 15 anos&#44; e um EBDR de 22 anos&#41;&#46; Um paciente EBDR de 24 anos teve broncoaspira&#231;&#227;o como causa de morte&#46; Duas crian&#231;as EBDD&#44; de 1 ano e de 11 anos&#44; foram a &#243;bito sem causa conhecida&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Pacientes que n&#227;o compareceram a consultas na dermatologia e em outras especialidades no HC&#8208;FMUSP h&#225; mais de dois anos foram considerados perda de seguimento&#46; No total&#44; 158 &#40;57&#37;&#41; pacientes tiveram data da &#250;ltima consulta antes de 31&#47;12&#47;2020&#46; Entre 2021 e 2022&#44; tr&#234;s pacientes foram a &#243;bito&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0120" class="elsevierStylePara elsevierViewall">Em nosso estudo de EB heredit&#225;ria&#44; n&#227;o observamos predile&#231;&#227;o por sexo&#59; o n&#250;mero de mulheres e homens acometidos foi semelhante&#44; conforme previamente descrito na literatura&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2&#44;17</span></a> A forma distr&#243;fica de EB foi a mais frequente &#40;73&#44;4&#37;&#41;&#44; propor&#231;&#227;o semelhante &#224; encontrada em estudo realizado no Ir&#227; &#40;75&#44;7&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> Estudos de outros pa&#237;ses descreveram frequ&#234;ncia menor de EBD&#44; como Canad&#225; &#40;35&#37;&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">18</span></a> Austr&#225;lia &#40;35&#37;&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a> Holanda<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a> com 34&#44;7&#37; &#40;EBDD 23&#44;1&#37; e EBDR 11&#44;4&#37;&#41;&#44; Alemanha &#40;32&#44;5&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a> e &#205;ndia &#40;17&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">22</span></a> A predomin&#226;ncia de formas mais graves de EB em nosso estudo se deve&#44; em parte&#44; a dificuldades de acesso a atendimento m&#233;dico especializado<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">23</span></a> em nosso pa&#237;s e subdiagn&#243;stico das formas mais localizadas de EBS e ao fato de o HC&#8208;FMUSP ser hospital terci&#225;rio&#44; refer&#234;ncia nacional no atendimento de paciente com EB&#44; e atender casos de mais alta complexidade&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">No presente estudo&#44; EBS acometeu 16&#44;5&#37; dos pacientes&#44; enquanto EBJ 9&#44;4&#37; dos pacientes e EBK 1&#44;1&#37;&#46; A frequ&#234;ncia de EBJ no estudo do Ir&#227;&#44;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> Canad&#225;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">18</span></a> e Austr&#225;lia<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a> foi de 11&#37;&#59; na Holanda<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a> de 18&#44;8&#37; e na Alemanha&#44;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a> 17&#44;1&#37;&#46; J&#225; EBK&#44; 3&#37; no Ir&#227;&#44;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> 0&#44;3&#37; na Austr&#225;lia&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a> 0&#44;9&#37; na Holanda<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a> e 0&#44;5&#37; na Alemanha&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a> Em ambos os tipos de EB&#44; as porcentagens encontradas em nosso estudo foram semelhantes&#46; Em rela&#231;&#227;o &#224; EBS&#44; a frequ&#234;ncia encontrada &#233; menor do que a descrita na literatura&#44; uma vez que a popula&#231;&#227;o estudada adv&#233;m de hospital terci&#225;rio&#46; Segundo estudo epidemiol&#243;gico de 2021<span class="elsevierStyleHsp" style=""></span>da Holanda&#44;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a> EBS foi diagnosticada em 45&#44;7&#37;&#46; Nessa coorte holandesa&#44; 90&#44;5&#37; dos pacientes tiveram diagn&#243;stico geneticamente confirmado&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a> Dados epidemiol&#243;gicos de 1&#46;779 pacientes da Alemanha&#44; publicados em 2022&#44;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a> mostraram 39&#44;3&#37; &#40;700&#41; de pacientes EBS&#46; Este estudo incluiu pacientes de hospitais terci&#225;rios&#44; ambulat&#243;rios de Dermatologia&#44; laborat&#243;rios que realizaram o diagn&#243;stico e de organiza&#231;&#245;es de pacientes&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">A m&#233;dia da idade atual encontrada em nosso estudo foi de 26 anos&#44; e somente 40 &#40;14&#37;&#41; indiv&#237;duos tinham menos de 10 anos&#46; O elevado n&#250;mero de pacientes na idade puberal&#44; ou seja&#44; acima de 11 anos&#44; permite inferir aumento na expectativa de vida e reflete a melhora nos cuidados multidisciplinares&#44; principalmente em rela&#231;&#227;o &#224; nutri&#231;&#227;o&#44; infec&#231;&#227;o e manejo da dor&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Quanto &#224; consanguinidade&#44; apenas 31 pacientes &#40;11&#37;&#41; declararam sua ocorr&#234;nci&#44; e a EBDR foi o tipo que mais acometeu a popula&#231;&#227;o em estudo &#40;25&#44;8&#37;&#41;&#46; Como a maioria dos pacientes n&#227;o realizou teste gen&#233;tico&#44; o diagn&#243;stico n&#227;o foi confirmado por esse m&#233;todo&#46; Na literatura&#44; &#233; relatado que o n&#250;mero de pacientes com forma autoss&#244;mica recessiva de EB pode estar associado &#224;s comunidades com altas taxas de consanguinidade parental&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">24</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">As queixas mais comuns dos pacientes foram altera&#231;&#245;es dent&#225;rias &#40;36&#37;&#41;&#44; seguido por anemia &#40;29&#37;&#41; e doen&#231;as ortop&#233;dicas &#40;24&#37;&#41;&#46; No estudo do Ir&#227;&#44; foi disfagia seguido de altera&#231;&#245;es dent&#225;rias&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> Esses achados dent&#225;rios se devem na EBJ &#224; hipoplasia do esmalte dent&#225;rio e presen&#231;a de depress&#245;es puntiformes &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3A</a>&#41;&#44; que s&#227;o achados cl&#237;nicos patognom&#244;nicos nessa forma de EB&#46; Essas altera&#231;&#245;es acarretam perda precoce de dentes e c&#225;ries&#46; Na EBDR&#44; microstomia e anquiloglossia s&#227;o observadas e dificultam a higiene dental di&#225;ria&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">25</span></a> Deve&#8208;se sempre levar em considera&#231;&#227;o os cuidados prec&#225;rios de higiene bucal na maioria dos doentes com EB &#40;<a class="elsevierStyleCrossRef" href="#fig0025">fig&#46; 5B</a>&#41;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Pseudosindactilia das m&#227;os &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2B</a>&#41; e dos p&#233;s &#233; complica&#231;&#227;o m&#250;sculo&#8208;esquel&#233;tica que ocorre principalmente na EBDR&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">25</span></a> O uso de luvas ou curativos para manter os quirod&#225;ctilos separados &#233; aconselhado nos pacientes com EB distr&#243;fica&#46; Em 2011&#44; o grupo de ortopedia especializado em m&#227;os do HC&#8208;FMUSP&#44; em conjunto com a equipe de Dermatologia pedi&#225;trica&#44; publicou dados de 59 pacientes com EB e deformidades nas m&#227;os&#44; dos quais 25 foram submetidos &#224; cirurgia&#44; com taxa elevada de reopera&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a> Estudo de 2019 do grupo da China<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">27</span></a> relatou 11 pacientes EBDR submetidos &#224; cirurgia e com seguimento por dois anos&#44; dos quais nove apresentaram perda da funcionalidade das m&#227;os pelo reestreitamento dos espa&#231;os interdigitais&#44; com ades&#227;o de d&#237;gitos e flex&#227;o de articula&#231;&#245;es metacarpofalangeanas e interfalangeanas&#46; Os outros dois pacientes foram reoperados ap&#243;s um ano em virtude de recidiva&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">O Registro Nacional de EB &#40;NEBR&#41; dos Estados Unidos com casu&#237;stica de 3&#46;280 pacientes acompanhados por per&#237;odo de 16 anos &#40;1986&#8208;2002&#41;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">28&#44;29</span></a> permanece como o maior estudo epidemiol&#243;gico sobre EB&#46; Demonstrou que a frequ&#234;ncia de estenose de es&#244;fago &#233; de 79&#44;1&#37; em pacientes com EBDR grave&#44; 37&#44;2&#37; para EBDR intermedi&#225;ria e 14&#44;3&#37; em EBJ&#44; com frequ&#234;ncias menores nos demais subtipos de EB&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">28</span></a> Em nosso estudo&#44; estenose de es&#244;fago foi identificada em 14&#37; do total de indiv&#237;duos&#59; 28&#44;4&#37; e 7&#44;7&#37; foram as frequ&#234;ncias observadas em pacientes com EBDR e EBJ&#44; respectivamente&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Em 2005&#44; foi publicado um trabalho envolvendo a Gastroenterologia e a Dermatologia Pedi&#225;trica do HC&#8208;FMUSP&#44;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a> que relatou 19 pacientes com formas graves de EB &#40;EBD e EBJ&#41; atendidos entre janeiro de 1999 e abril de 2001&#46; V&#244;mitos e disfagia foram referidos por 16 &#40;84&#44;2&#37;&#41; casos&#44; engasgos por 14 &#40;73&#44;7&#37;&#41; e constipa&#231;&#227;o intestinal por 14 &#40;73&#44;7&#37;&#41; pacientes&#46; Anemia acometeu todos os casos&#46; Em rela&#231;&#227;o aos aspectos nutricionais&#44; 12 &#40;63&#44;1&#37;&#41; apresentavam peso e estatura inferiores ao percentil 2&#44;5&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a> No presente estudo&#44; desnutri&#231;&#227;o acometeu 35 &#40;12&#37;&#41;&#46; O menor percentual encontrado est&#225; associado &#224; metodologia deste trabalho&#44; que incluiu todas as formas de EB&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Nevo EB &#233; descrito como nevo adquirido&#44; eruptivo&#44; assim&#233;trico e acomete cerca de 14&#37; dos portadores de EB&#44; em suas v&#225;rias formas cl&#237;nicas&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">31</span></a> Os nevos EB geralmente ocorrem em s&#237;tios de bolhas pr&#233;vias e podem involuir espontaneamente&#46; Entretanto&#44; teoricamente o melanoma poderia surgir a partir do nevo EB ou de les&#245;es pigmentadas que mimetizam clinicamente o nevo EB&#46; Dessa maneira&#44; qualquer mudan&#231;a morfol&#243;gica no nevo EB&#44; em especial o surgimento de nodula&#231;&#227;o ou ulcera&#231;&#227;o&#44; aponta para a realiza&#231;&#227;o de estudo histopatol&#243;gico&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">32</span></a> Neste estudo&#44; nevos EB foram identificados em 17&#37; dos pacientes&#46; Em 2014&#44; a equipe de Dermatologia Pedi&#225;trica do HC&#8208;FMUSP descreveu 13 pacientes EBD com nevos EB&#44; cinco dos quais foram biopsiados em virtude das caracter&#237;sticas dermatosc&#243;picas at&#237;picas dos nevos&#46; Dois corresponderam a nevo at&#237;pico ou prolifera&#231;&#227;o lentiginosa at&#237;pica &#224; avalia&#231;&#227;o histopatol&#243;gica&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a> Em 2005&#44; um grupo da &#193;ustria<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">33</span></a> descreveu caracter&#237;sticas dermatosc&#243;picas de 23 nevos EB de 11 pacientes&#44; com crit&#233;rios associados a melanoma encontrados&#44; como padr&#227;o multicomponentes &#40;20 de 23&#41;&#44; rede pigmentada at&#237;pica &#40;17 de 23&#41;&#44; gl&#243;bulos e pontos irregulares &#40;16 de 23&#41;&#44; pigmenta&#231;&#227;o irregular &#40;22 de 23&#41; e padr&#227;o vascular at&#237;pico &#40;7 de 23&#41;&#46; O mesmo grupo indicou avalia&#231;&#227;o histol&#243;gica de les&#245;es altamente suspeitas&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">A atresia de piloro associada &#224; EB foi encontrada em uma paciente feminina EBS de 28 anos e com acometimento cut&#226;neo extenso&#46; Trata&#8208;se de um subtipo distinto&#44; que geralmente ocorre em fen&#243;tipos graves de EB&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">34</span></a> Quando ocorre concomitantemente &#224; EBS grave&#44; est&#225; associada &#224; muta&#231;&#227;o no gene da plectina &#40;PLEC&#41;&#44; prote&#237;na formadora do hemidesmossoma&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a> O diagn&#243;stico gen&#233;tico da paciente em quest&#227;o ainda n&#227;o foi realizado&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Um paciente masculino EBS de 22 anos com diagn&#243;stico gen&#233;tico de muta&#231;&#227;o no gene PLEC apresentou distrofia muscular&#44; como j&#225; citado na literatura&#46; Pode estar presente ao nascimento ou nos primeiros dias de vida nas crian&#231;as com doen&#231;a cut&#226;nea grave&#44;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">35</span></a> ou pode se estabelecer de forma insidiosa no final da inf&#226;ncia ou na vida adulta&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">25</span></a> No estudo holand&#234;s de 2021&#44;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a> dois pacientes com EBS e distrofia muscular morreram com idades de 43&#44;7 anos e 46 anos por fal&#234;ncia card&#237;aca&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">O maior risco de cardiomiopatia dilatada &#233; visto entre pacientes EBDR grave&#44; com risco cumulativo de 4&#44;51&#37; aos 20 anos de idade&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">36</span></a> Dentre os pacientes inclu&#237;dos neste estudo&#44; cardiomiopatia acometeu um paciente EBDR&#44; que foi a &#243;bito aos 20 anos&#44; e um paciente EBK de 30 anos&#44; que perdeu seguimento&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Durante o per&#237;odo avaliado&#44; foram realizadas 302 biopsias de pele e 359 imunomapeamentos&#46; Alguns exames foram repetidos em virtude de laudos inconclusivos&#44; pois as bolhas biopsiadas estavam em processo de reepiteliza&#231;&#227;o ou a clivagem estava ausente&#46; O exame histol&#243;gico da biopsia de pele deve ser realizado em uma bolha &#237;ntegra &#40;pele acometida&#41; recente&#46; A clivagem &#233; intraepid&#233;rmica nos casos de EBS e subepid&#233;rmica na EBJ e EBD&#44; n&#227;o sendo poss&#237;vel diferenciar essas duas formas por meio da histopatologia com colora&#231;&#227;o de rotina&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">10</span></a> Na EBK&#44; o plano de clivagem &#233; vari&#225;vel&#46; J&#225; o imunomapeamento pode ser realizado em amostra de pele s&#227; com ves&#237;cula induzida ou em ves&#237;cula recente e idealmente pequena&#44; para que n&#227;o se rompa no ato da biopsia&#46; Trata&#8208;se de t&#233;cnica de imunofluoresc&#234;ncia e tem a vantagem de possibilitar a visualiza&#231;&#227;o do plano de clivagem&#44; permitindo diferencia&#231;&#227;o entre as formas simples&#44; juncional e distr&#243;fica&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">10</span></a> Os marcadores utilizados no Departamento de Dermatologia do HC&#8208;FMUSP s&#227;o&#58; ant&#237;geno do penfigoide bolhoso &#40;marcador de hemidesmossoma&#41;&#44; anticorpo antilaminina 5 &#40;l&#226;mina l&#250;cida&#41;&#44; anticorpo anticol&#225;geno IV &#40;l&#226;mina densa&#41; e anticorpo anticol&#225;geno VII &#40;subl&#226;mina densa e fibrilas de ancoragem&#41;&#46; Na EBS&#44; a clivagem ocorre na camada basal&#46; Na EBJ&#44; o n&#237;vel de clivagem ocorre na l&#226;mina l&#250;cida&#44; enquanto na EBD ocorre na subl&#226;mina densa &#40;<a class="elsevierStyleCrossRef" href="#fig0035">fig&#46; 7</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">10</span></a> Na EBDR&#44; h&#225; aus&#234;ncia ou diminui&#231;&#227;o acentuada da fluoresc&#234;ncia com o col&#225;geno VII&#46; Em 2021&#44; um estudo da &#205;ndia<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">37</span></a> mostrou a utilidade do imunomapeamento como m&#233;todo diagn&#243;stico&#44; frente &#224; indisponibilidade de microscopia eletr&#244;nica e de testes gen&#233;ticos&#46; Diagn&#243;stico de 104 EBS&#44; 28 EBJ e de 26 EBD foi realizado com taxa de concord&#226;ncia de 41&#44;3&#37;&#44; com maiores taxas nos casos de EBS&#46;</p><elsevierMultimedia ident="fig0035"></elsevierMultimedia><p id="par0185" class="elsevierStylePara elsevierViewall">A pesquisa das muta&#231;&#245;es nos genes associados &#224; EB &#233; padr&#227;o ouro para defini&#231;&#227;o do subtipo de EB e evitaria a realiza&#231;&#227;o de biopsia e imunomapeamento&#46; Tem sido realizada de maneira mais r&#225;pida e menos custosa&#44; com maiores taxas de detec&#231;&#227;o mutacional&#44; devido aos avan&#231;os na tecnologia de sequenciamento&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">38</span></a> No nosso servi&#231;o&#44; teste gen&#233;tico vem sendo realizado no &#226;mbito da pesquisa&#44; por&#233;m ainda n&#227;o est&#225; amplamente dispon&#237;vel na pr&#225;tica ambulatorial por n&#227;o ser exame coberto pelo SUS&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Em algumas formas de EB&#44; especialmente na EBDR&#44; h&#225; risco aumentado de CEC no final da adolesc&#234;ncia e in&#237;cio da vida adulta&#46; Estudo recente do grupo da Austr&#225;lia e da Nova Zel&#226;ndia<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">39</span></a> mostrou 16 pacientes EBDR com 161 CEC prim&#225;rios&#44; com m&#233;dia de 10 CEC por indiv&#237;duo&#46; Desses tumores&#44; 70&#37; surgiram nas m&#227;os e nos p&#233;s&#44; principalmente em &#225;reas de &#250;lceras cr&#244;nicas e de feridas que n&#227;o cicatrizavam&#46; Met&#225;stase foi detectada em 11 &#40;68&#44;7&#37;&#41; desses pacientes&#46; Amputa&#231;&#227;o parcial do membro foi realizado em sete casos&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">39</span></a> Dos nove pacientes diagnosticados com CEC em nosso estudo&#44; sete &#40;77&#44;7&#37;&#41; apresentaram tumor nos membros inferiores e cinco &#40;55&#44;5&#37;&#41; tiveram met&#225;stase&#46; Apenas um indiv&#237;duo EBJ apresentou mais de um CEC &#40;tr&#234;s tumores&#41;&#44; enquanto tr&#234;s pacientes foram submetidos &#224; amputa&#231;&#227;o transtibial&#46; CEC &#233; a principal causa de morte nesse grupo de pacientes&#44; e o risco cumulativo de morte por met&#225;stase &#233; de 38&#44;7&#37; aos 35 anos e de 78&#44;8&#37; aos 55 anos de idade&#46; A maioria dos pacientes com EBDR morrem de CEC metast&#225;tico no per&#237;odo de cinco anos ap&#243;s o diagn&#243;stico&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">29</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">O baixo n&#250;mero de &#243;bitos &#40;11&#41; identificado neste estudo pode estar relacionado aos cuidados multidisciplinares dirigidos aos pacientes&#46; Por&#233;m&#44; h&#225; o vi&#233;s de informa&#231;&#227;o&#44; pois esse dado somente &#233; registrado no prontu&#225;rio quando o &#243;bito ocorre em algum hospital do complexo HC&#8208;FMUSP&#46; Informa&#231;&#245;es sobre &#243;bitos que ocorrem em casa ou em outros hospitais n&#227;o est&#227;o dispon&#237;veis&#44; pela falta de um banco de dados unificado nacional&#46; Cinco pacientes EBDR foram a &#243;bito com m&#233;dia de idade de 20&#44;4 anos&#44; enquanto a m&#233;dia de idade de &#243;bito de cinco pacientes EBDD foi de 14 anos&#46; A idade m&#233;dia de vida em pacientes com EBD segundo estudo recente na Holanda &#233; de 32&#44;5 anos&#46; Em EBDR&#44; esse valor &#233; de 28&#44;8 anos e em EBDD de 33&#44;3 anos&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">Quanto &#224;s principais limita&#231;&#245;es&#44; por se tratar de um estudo retrospectivo com longo per&#237;odo de avalia&#231;&#227;o &#40;2000&#8208;2022&#41;&#44; houve falta de informa&#231;&#245;es em alguns prontu&#225;rios m&#233;dicos e perda de seguimento de pacientes&#46; Outro ponto &#233; a indisponibilidade de testes gen&#233;ticos de rotina para os pacientes com EB em nosso servi&#231;o e no sistema p&#250;blico de sa&#250;de&#44; o que pode dificultar a classifica&#231;&#227;o da forma cl&#237;nica de EB&#46; Apesar desse estudo n&#227;o ser multic&#234;ntrico&#44; representa o primeiro trabalho com dados epidemiol&#243;gicos de epiderm&#243;lise bolhosa heredit&#225;ria na popula&#231;&#227;o brasileira&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">No Brasil&#44; o HC&#8208;FMUSP &#233; um dos poucos centros de refer&#234;ncia multidisciplinar especializados em EB&#46; O acesso a esses servi&#231;os escassos &#233; dif&#237;cil&#44; uma vez que depende do encaminhamento das unidades b&#225;sicas de sa&#250;de&#44; que muitas vezes s&#227;o distantes e localizam&#8208;se at&#233; mesmo em outros Estados&#44; de forma que o nosso servi&#231;o atende pacientes de todo o pa&#237;s&#46; Outro problema cr&#237;tico &#233; a falta de suprimento de necessidades b&#225;sicas dos pacientes&#44; como curativos n&#227;o&#8208;aderentes e at&#233; mesmo curativos simples&#46; Muitas vezes o paciente de EB n&#227;o &#233; diagnosticado e tratado adequadamente&#46; H&#225; subdiagn&#243;stico e os poucos dados epidemiol&#243;gicos que s&#227;o publicados acabam n&#227;o refletindo a realidade da incid&#234;ncia e preval&#234;ncia de doen&#231;as raras&#44; como a EB&#46; Semelhante ao que ocorre no Canad&#225;&#44; n&#227;o h&#225; centros especializados no cuidado de adultos com EB e esses continuam sendo atendidos em ambulat&#243;rios pedi&#225;tricos&#46; Quest&#245;es da vida adulta&#44; como sexualidade&#44; emprego&#44; independ&#234;ncia e manejo de c&#226;ncer de pele s&#227;o tratados com limita&#231;&#245;es&#44; o que torna necess&#225;rio o encaminhamento a outras especialidades&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">40</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#227;o</span><p id="par0210" class="elsevierStylePara elsevierViewall">Em doen&#231;as raras como a EB&#44; dados epidemiol&#243;gicos confi&#225;veis permitem a identifica&#231;&#227;o de tend&#234;ncias epidemiol&#243;gicas&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">14</span></a> Esse estudo demonstra a predomin&#226;ncia de formas mais graves na nossa casu&#237;stica &#40;EB distr&#243;fica&#41;&#44; provavelmente por se tratar de um hospital terci&#225;rio&#44; e ressalta a necessidade de cuidado multidisciplinar&#44; principalmente em rela&#231;&#227;o &#224;s comorbidades e &#224;s complica&#231;&#245;es dos pacientes&#44; como anemia&#44; doen&#231;as dent&#225;rias&#44; ortop&#233;dicas e do trato gastrointestinal e carcinoma espinocelular&#46; No Brasil&#44; h&#225; a necessidade de cria&#231;&#227;o de banco de dados que unifique informa&#231;&#245;es cl&#237;nicas de toda a popula&#231;&#227;o&#44; a fim de identificar essas tend&#234;ncias e permitir melhor direcionamento das pol&#237;ticas de sa&#250;de &#40;verbas e financiamento&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Suporte financeiro</span><p id="par0215" class="elsevierStylePara elsevierViewall">Estudo patrocinado pela Fundo de Apoio &#224; Dermatologia do Estado de S&#227;o Paulo &#40;FUNADERSP&#41; &#91;PROJETO 105&#8208;2022&#93; e pelo Departamento de Dermatologia do Hospital das Cl&#237;nicas da Universidade de S&#227;o Paulo&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Contribui&#231;&#227;o dos autores</span><p id="par0220" class="elsevierStylePara elsevierViewall">Chan I&#46; Thien&#58; concep&#231;&#227;o e planejamento do estudo&#59; coleta de dados ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; an&#225;lise estat&#237;stica&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Vanessa Rolim Bessa&#58; Coleta de dados&#44; ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; an&#225;lise estat&#237;stica&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Isadora Zago Miotto&#58; Coleta de dados&#44; ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; an&#225;lise estat&#237;stica&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Luciana Paula Samorano&#58; Concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Maria Cec&#237;lia Rivitti Machado&#58; Concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Zilda Najjar Prado de Oliveira&#58; Concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#59; an&#225;lise estat&#237;stica&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflito de interesses</span><p id="par0250" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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            2 => "Epidemiologia"
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            4 => "Epiderm&#243;lise bolhosa distr&#243;fica"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Epiderm&#243;lise bolhosa &#40;EB&#41; &#233; um grupo de doen&#231;as heredit&#225;rias raras&#44; caracterizadas por fragilidade da pele e mucosas&#46; Dados epidemiol&#243;gicos de EB no Brasil s&#227;o escassos&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Descrever aspectos epidemiol&#243;gicos de pacientes com EB diagnosticados no Departamento de Dermatologia de um hospital terci&#225;rio&#44; de 2000 at&#233; 2022&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudo observacional e retrospectivo foi conduzido por meio da an&#225;lise de prontu&#225;rios&#46; Dados avaliados inclu&#237;ram forma cl&#237;nica&#44; sexo&#44; hist&#243;ria familiar&#44; consanguinidade&#44; idade ao diagn&#243;stico&#44; idade atual&#44; tempo de seguimento&#44; comorbidades&#44; exame histopatol&#243;gico e imunomapeamento&#44; presen&#231;a de nevos EB e de carcinomas espinocelulares &#40;CEC&#41;&#44; causa e idade da morte&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Dos 309 pacientes com EB heredit&#225;ria&#44; 278 foram inclu&#237;dos&#46; O tipo mais comum foi EB distr&#243;fica &#40;EBD&#41;&#44; com 73&#37; &#40;28&#44;4&#37; EBD dominante&#44; 31&#44;7&#37; EBD recessiva e 12&#44;9&#37; EBD pruriginosa&#41;&#46; Outros tipos foram juncional com 9&#44;4&#37;&#44; simples com 16&#44;5&#37; e Kindler com 1&#44;1&#37;&#46; Mulheres corresponderam a 53&#37; e homens a 47&#37;&#46; Hist&#243;ria familiar foi encontrada em 35&#37; e consanguinidade em 11&#37;&#46; A m&#233;dia de idade ao diagn&#243;stico foi de 10&#44;8 anos&#44; e da idade atual foi de 26 anos&#46; A m&#233;dia do tempo de seguimento foi de nove anos&#46; Estenose de es&#244;fago acometeu 14&#37;&#44; doen&#231;as dent&#225;rias acometeram 36&#37;&#44; desnutri&#231;&#227;o 13&#37; e anemia 29&#37; dos indiv&#237;duos&#46; Durante a investiga&#231;&#227;o diagn&#243;stica&#44; 72&#44;6&#37; realizaram exame histopatol&#243;gico e 92&#37; fizeram imunomapeamento&#46; Nevos EB foram identificados em 17&#37;&#46; Nove pacientes tiveram CEC&#46; Onze foram a &#243;bito&#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">Dados insuficientes nos prontu&#225;rios&#44; perda de seguimento e indisponibilidade do teste gen&#233;tico&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#245;es</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Neste estudo&#44; predominou EB distr&#243;fica e ressaltou&#8208;se a necessidade de cuidado multidisciplinar das comorbidades e das complica&#231;&#245;es&#46;</p></span>"
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                  \t\t\t\t">EBS&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">23&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">46&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3522980.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Distribui&#231;&#227;o do tipo de epiderm&#243;lise bolhosa em rela&#231;&#227;o ao sexo&#44; ao hist&#243;rico familiar e &#224; consanguinidade</p>"
        ]
      ]
      8 => 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:1 [
          "tablatextoimagen" => array:2 [
            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  " colspan="13" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Idade ao diagn&#243;stico</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">0 a 1 ano&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">1 a 10&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">11 a 20&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">21 a 30&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">31 a 40&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">41 a 50&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">51 a 60&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">61 a 70&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">71 a 80&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">81 a 90&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">Total&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></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">EBS&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">20&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&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&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&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&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&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&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&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&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&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">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">16&#44;5&#37;&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">EBJ&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&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&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&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&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&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">2&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&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&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&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&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">26&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;4&#37;&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">EBDD&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">24&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&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&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&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&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&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&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">1&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&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&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">79&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">28&#44;4&#37;&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">EBDR&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">38&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">40&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">6&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">1&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">2&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&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&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&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</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">88&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">31&#44;7&#37;&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">EBD pruriginosa&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&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">5&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">5&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">5&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">7&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&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&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">4&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&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&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">36&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">12&#44;9&#37;&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">EBK&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&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&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&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&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&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&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&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&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\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">1&#44;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">93&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">103&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&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&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&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">12&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">5&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">5&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&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">1&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">278&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></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3522979.png"
              ]
            ]
            1 => 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  " colspan="13" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Idade atual &#40;ou do &#243;bito&#41;</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="" 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
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                  \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">0 a 10&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">11 a 20&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">21 a 30&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">31 a 40&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">41 a 50&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">51 a 60&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">61 a 70&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">71 a 80&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">81 a 90&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">Total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \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-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \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
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                  \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&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">15&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">5&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">3&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&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&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&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&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">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">16&#44;5&#37;&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">EBJ&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">6&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&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&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&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&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&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&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&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&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">26&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  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3522982.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Distribui&#231;&#227;o do tipo de epiderm&#243;lise bolhosa quanto &#224; idade ao diagn&#243;stico e quanto &#224; idade atual&#46; No caso de pacientes que foram a &#243;bito&#44; foi considerada a idade da morte</p>"
        ]
      ]
      9 => 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 [
          "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
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                  \t\t\t\t  " colspan="7" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Comorbidades</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
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                  \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">Estenose de es&#244;fago&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">Altera&#231;&#227;o dent&#225;ria&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">Desnutri&#231;&#227;o&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" scope="col" style="border-bottom: 2px solid black">Anemia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">N&#176; acometidos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#37; &#40;n&#176; acometidos&#47;total pacientes&#41;&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estrabismo &#40;1&#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"><span class="elsevierStyleHsp" style=""></span>&#218;lcera c&#243;rnea &#40;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">Conjuntivite &#40;1&#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">Simbl&#233;faro &#40;1&#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"><span class="elsevierStyleHsp" style=""></span>Blefarite &#40;1&#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">Descolamento de retina &#40;1&#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">Miopia &#40;2&#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"><span class="elsevierStyleHsp" style=""></span>Stafiloma da m&#225;cula &#40;1&#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
                  \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"><span class="elsevierStyleItalic">Gastroenterol&#243;gicas</span>&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"><span class="elsevierStyleHsp" style=""></span>Estenose de es&#244;fago &#40;40&#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">Megac&#243;lon &#40;1&#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">S&#237;ndrome disp&#233;ptica &#40;3&#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"><span class="elsevierStyleHsp" style=""></span>Doen&#231;a do refluxo gastroesof&#225;gico &#40;3&#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">Constipa&#231;&#227;o &#40;7&#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></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"><span class="elsevierStyleItalic">Otorrinolaringol&#243;gicas</span>&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"><span class="elsevierStyleHsp" style=""></span>Otite &#40;3&#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">Rouquid&#227;o &#40;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">Discinesia far&#237;ngea &#40;1&#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"><span class="elsevierStyleHsp" style=""></span>Hipoacusia &#40;1&#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">Laringomal&#225;cia &#40;1&#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">Tumor do seio maxilar direito &#40;1&#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"><span class="elsevierStyleHsp" style=""></span>S&#237;ndrome da apneia e da hipopneia obstrutivas do sono &#40;1&#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
                  \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"><span class="elsevierStyleItalic">Ortop&#233;dicas</span>&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"><span class="elsevierStyleHsp" style=""></span>Pseudosindactilia &#40;56&#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">Malforma&#231;&#227;o &#243;ssea &#40;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">Osteomielite &#40;1&#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"><span class="elsevierStyleHsp" style=""></span>Deformidade articular &#40;1&#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">Assimetria de membros inferiores &#40;1&#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></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"><span class="elsevierStyleItalic">Endocrinol&#243;gicas</span>&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"><span class="elsevierStyleHsp" style=""></span>Hipotireoidismo &#40;8&#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">Diabete <span class="elsevierStyleItalic">mellitus</span> &#40;5&#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">Baixa estatura &#40;2&#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"><span class="elsevierStyleHsp" style=""></span>Osteoporose &#40;3&#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">Puberdade tardia &#40;1&#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">Puberdade precoce &#40;1&#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"><span class="elsevierStyleHsp" style=""></span>Diabete <span class="elsevierStyleItalic">mellitus</span> insulinodependente &#40;1&#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">N&#243;dulo tireoideano &#40;1&#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></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"><span class="elsevierStyleItalic">Hematol&#243;gicas</span>&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"><span class="elsevierStyleHsp" style=""></span>Anemia &#40;82&#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">Tra&#231;o falc&#234;mico &#40;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">Defici&#234;ncia de G&#8208;6&#8208;PD &#40;1&#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"><span class="elsevierStyleHsp" style=""></span>Mieloma m&#250;ltiplo &#40;1&#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">P&#250;rpura trombocitop&#234;nica idiop&#225;tica &#40;1&#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></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"><span class="elsevierStyleItalic">Psiqui&#225;tricas</span>&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"><span class="elsevierStyleHsp" style=""></span>Depress&#227;o &#40;1&#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">Idea&#231;&#227;o suicida &#40;1&#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">S&#237;ndrome do p&#226;nico &#40;1&#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"><span class="elsevierStyleItalic">Pneumol&#243;gicas</span>&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"><span class="elsevierStyleHsp" style=""></span>Asma &#40;3&#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">Rinite al&#233;rgica &#40;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">Estenose de traqueia &#40;1&#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"><span class="elsevierStyleItalic">Cardiol&#243;gicas</span>&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"><span class="elsevierStyleHsp" style=""></span>Hipertens&#227;o arterial &#40;13&#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">Cardiomiopatia dilatada &#40;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">Doen&#231;a de Chagas &#40;1&#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"><span class="elsevierStyleHsp" style=""></span>Angina &#40;1&#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">Cardiopatia &#40;CIA&#44; estenose a&#243;rtica e pulmonar&#41; &#40;1&#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></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"><span class="elsevierStyleItalic">Urol&#243;gicas</span>&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"><span class="elsevierStyleHsp" style=""></span>Infec&#231;&#227;o urin&#225;ria &#40;3&#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">Criptorquidismo &#40;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">Estenose uretral &#40;1&#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"><span class="elsevierStyleItalic">Nefrol&#243;gicas</span>&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"><span class="elsevierStyleHsp" style=""></span>Nefropatia &#40;1&#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">Nefrite por IgA &#40;1&#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></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Outras manifesta&#231;&#245;es extracut&#226;neas encontradas nos pacientes deste estudo&#44; com o n&#250;mero de indiv&#237;duos acometidos entre par&#234;nteses</p>"
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      "titulo" => "Refer&#234;ncias"
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        0 => array:2 [
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          "bibliografiaReferencia" => array:40 [
            0 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Consensus reclassification of inherited epidermolysis bullosa and other disorders with skin fragility"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Has"
                            1 => "J&#46;W&#46; Bauer"
                            2 => "C&#46; Bodemer"
                            3 => "M&#46;C&#46; Bolling"
                            4 => "L&#46; Bruckner-Tuderman"
                            5 => "A&#46; Diem"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Br J Dermatol&#46;"
                        "fecha" => "2020"
                        "volumen" => "183"
                        "paginaInicial" => "614"
                        "paginaFinal" => "627"
                      ]
                    ]
                  ]
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            1 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Epidermolysis bullosa"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Bardhan"
                            1 => "L&#46; Bruckner-Tuderman"
                            2 => "I&#46;L&#46;C&#46; Chapple"
                            3 => "J&#46;D&#46; Fine"
                            4 => "N&#46; Harper"
                            5 => "C&#46; Has"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/s41572-020-0210-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Rev Dis Primers&#46;"
                        "fecha" => "2020"
                        "volumen" => "6"
                        "paginaInicial" => "78"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32973163"
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            2 => array:3 [
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              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An overview of the genetic basis of epidermolysis bullosa in Brazil&#58; discovery of novel and recurrent disease&#8208;causing variants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "L&#46;M&#46; Mariath"
                            1 => "J&#46;T&#46; Santin"
                            2 => "J&#46;A&#46; Frantz"
                            3 => "M&#46;J&#46;R&#46; Doriqui"
                            4 => "A&#46;E&#46; Kiszewski"
                            5 => "L&#46; Schuler-Faccini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/cge.13555"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Genet&#46;"
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                        "paginaFinal" => "198"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31001817"
                            "web" => "Medline"
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            3 => array:3 [
              "identificador" => "bib0220"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inherited epidermolysis bullosa&#58; update on the clinical and genetic aspects"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46;M&#46; Mariath"
                            1 => "J&#46;T&#46; Santin"
                            2 => "L&#46; Schuler-Faccini"
                            3 => "A&#46;E&#46; Kiszewski"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.abd.2020.05.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "An Bras Dermatol&#46;"
                        "fecha" => "2020"
                        "volumen" => "95"
                        "paginaInicial" => "551"
                        "paginaFinal" => "569"
                        "link" => array:1 [
                          0 => array:2 [
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            4 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidermolysis bullosa nevi&#58; clinical&#44; dermatoscopical and histological features in a case of recessive dystrofic form"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;N&#46; Melo"
                            1 => "P&#46;Y&#46; Teruya"
                            2 => "M&#46;C&#46; Machado"
                            3 => "N&#46;S&#46; Valente"
                            4 => "M&#46;N&#46; Sotto"
                            5 => "Z&#46;N&#46; Oliveira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/s0365-05962011000400017"
                      "Revista" => array:6 [
                        "tituloSerie" => "An Bras Dermatol&#46;"
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                        "volumen" => "86"
                        "paginaInicial" => "743"
                        "paginaFinal" => "746"
                        "link" => array:1 [
                          0 => array:2 [
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                            "web" => "Medline"
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            5 => array:3 [
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              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Underrecognition of epidermolysis bullosa pruriginosa"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;C&#46; Cha"
                            1 => "L&#46;P&#46; Samorano"
                            2 => "F&#46;M&#46; Dacache"
                            3 => "M&#46;C&#46; Rivitti-Machado"
                            4 => "Z&#46;N&#46;P&#46; de Oliveira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Dtsch Dermatol Ges&#46;"
                        "fecha" => "2015"
                        "volumen" => "13"
                        "paginaInicial" => "1035"
                        "paginaFinal" => "1038"
                      ]
                    ]
                  ]
                ]
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            6 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical&#44; dermoscopic and histopathological features of melanocytic nevi in dystrophic epidermolysis bullosa"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;D&#46; Fernandes"
                            1 => "M&#46;C&#46; Rivitti-Machado"
                            2 => "J&#46; Nakano"
                            3 => "B&#46; de Oliveira Rocha"
                            4 => "Z&#46;N&#46;P&#46; Oliveira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/ddg.12258"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Dtsch Dermatol Ges&#46;"
                        "fecha" => "2014"
                        "volumen" => "12"
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                        "paginaFinal" => "242"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24533826"
                            "web" => "Medline"
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            7 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gene panel for the diagnosis of epidermolysis bullosa&#58; proposal for a viable and efficient approach"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "L&#46;M&#46; Mariath"
                            1 => "A&#46;E&#46; Kiszewski"
                            2 => "J&#46;A&#46; Frantz"
                            3 => "M&#46; Siebert"
                            4 => "U&#46; Matte"
                            5 => "L&#46; Schuler-Faccini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.abd.2020.05.015"
                      "Revista" => array:6 [
                        "tituloSerie" => "An Bras Dermatol&#46;"
                        "fecha" => "2021"
                        "volumen" => "96"
                        "paginaInicial" => "155"
                        "paginaFinal" => "162"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33640189"
                            "web" => "Medline"
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            8 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pretibial dystrophic epidermolysis bullosa"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46;A&#46;C&#46; Callegaro"
                            1 => "F&#46; Nappi"
                            2 => "R&#46; Lazzarini"
                            3 => "R&#46;F&#46; Lellis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "An Bras Dermatol&#46;"
                        "fecha" => "2017"
                        "volumen" => "92"
                        "paginaInicial" => "126"
                        "paginaFinal" => "128"
                      ]
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                  ]
                ]
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            9 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Immunological mapping in hereditary epidermolysis bullosa"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Z&#46;N&#46;P&#46; Oliveira"
                            1 => "A&#46;M&#46; P&#233;rigo"
                            2 => "L&#46;M&#46; Fukumori"
                            3 => "V&#46; Aoki"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
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Artigo original
Epidermólise bolhosa hereditária: perfil clínico‐epidemiológico de 278 pacientes em hospital terciário em São Paulo, Brasil
Chan I. Thien
Corresponding author
ithienchan@gmail.com

Autor para correspondência.
, Vanessa Rolim Bessa, Isadora Zago Miotto, Luciana Paula Samorano, Maria Cecília Rivitti Machado, Zilda Najjar Prado de Oliveira
Departamento de Dermatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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em que a clivagem na pele &#233; muito superficial &#40;suprabasal&#41;&#44; como s&#237;ndrome da pele dec&#237;dua&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a> Nas formas cl&#225;ssicas de EB&#44; o quadro cl&#237;nico &#233; heterog&#234;neo&#46; De acordo com o plano de clivagem na pele&#44; as EB s&#227;o divididas em quatro tipos principais&#58; EB simples &#40;EBS&#41;&#44; EB juncional &#40;EBJ&#41;&#44; EB Ddistr&#243;fica &#40;EBD&#41; e EB Kindler &#40;EBK&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a> Mais de 30 subtipos cl&#237;nicos s&#227;o reconhecidos e foram descritas muta&#231;&#245;es patog&#234;nicas em 21 genes distintos&#44; que codificam prote&#237;nas envolvidas na ades&#227;o e integridade celulares&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Dados epidemiol&#243;gicos no Brasil sobre EB s&#227;o escassos&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">3&#44;4</span></a> A associa&#231;&#227;o DEBRA Brasil tem registro de 1&#46;027 pacientes no pa&#237;s&#59; entretanto&#44; esse dado n&#227;o est&#225; publicado&#46; Os estudos brasileiros publicados s&#227;o relatos e s&#233;ries de casos com caracteriza&#231;&#227;o cl&#237;nica e alguns com an&#225;lise gen&#233;tica&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">3&#8211;13</span></a>Em doen&#231;as raras&#44; dados epidemiol&#243;gicos confi&#225;veis&#44; com base em coortes bem caracterizadas&#44; s&#227;o essenciais&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">14</span></a> Ressaltam a necessidade de aten&#231;&#227;o ao cuidado e aos custos para os sistemas de sa&#250;de de um pa&#237;s espec&#237;fico&#46; Tamb&#233;m s&#227;o importantes para o desenvolvimento e execu&#231;&#227;o de estudos cl&#237;nicos e para estimar o n&#250;mero de pacientes que poderiam se beneficiar com determinado tratamento&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a> Estudos cl&#237;nicos de fase 3 com Beremagene Geperpavec &#40;B&#8208;VEC&#41; em pacientes com EBD mostraram resultados promissores quanto &#224; cicatriza&#231;&#227;o de feridas&#46; Trata&#8208;se de terapia t&#243;pica gen&#233;tica associada &#224; edi&#231;&#227;o g&#234;nica&#44; com sequ&#234;ncias de COL7A1 encapsuladas em vetores virais de herpes simples tipo 1&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">O objetivo desse estudo foi descrever os achados cl&#237;nicos e epidemiol&#243;gicos da EB heredit&#225;ria de um hospital terci&#225;rio em S&#227;o Paulo&#44; Brasil&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Estudo observacional&#44; retrospectivo e transversal foi conduzido&#44; ap&#243;s aprova&#231;&#227;o do Comit&#234; de &#201;tica da institui&#231;&#227;o&#44; por meio da an&#225;lise de prontu&#225;rios f&#237;sicos e eletr&#244;nicos de 309 pacientes diagnosticados com EB&#44; na Divis&#227;o de Dermatologia do Hospital das Cl&#237;nicas da Faculdade de Medicina da Universidade de S&#227;o Paulo &#40;HC&#8208;FMUSP&#41;&#44; Brasil&#44; de 1 de janeiro de 2000 a 31 de dezembro de 2022&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">O diagn&#243;stico foi baseado na apresenta&#231;&#227;o cl&#237;nica&#44; hist&#243;ria familiar&#44; comorbidades e nos exames histol&#243;gico e de imunomapeamento obtidos por meio de material de biopsia de pele&#46; Os diagn&#243;sticos foram agrupados nas seguintes categorias&#58; EBS&#44; EBJ&#44; EBD dominante &#40;EBDD&#41;&#44; EBD recessiva &#40;EBDR&#41;&#44; EBD pruriginosa e EBK&#46; Pacientes com dados incompletos ou prontu&#225;rios m&#233;dicos indispon&#237;veis foram exclu&#237;dos&#44; assim como as doen&#231;as com clivagem suprabasal &#40;consenso de 2020&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a> Indiv&#237;duos com a doen&#231;a e familiares tamb&#233;m acometidos que n&#227;o estavam registrados no nosso servi&#231;o n&#227;o foram ativamente recrutados&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">O banco de dados utilizado nesse estudo incluiu forma cl&#237;nica de EB&#44; sexo&#44; hist&#243;ria familiar de EB&#44; presen&#231;a de consanguinidade&#44; idade de diagn&#243;stico&#44; idade atual&#44; tempo de seguimento&#44; comorbidades&#44; realiza&#231;&#227;o de exame histol&#243;gico e de imunomapeamento&#44; presen&#231;a de nevos EB e de tumores cut&#226;neos&#44; causa e idade de morte &#40;se aplic&#225;vel&#41;&#46; Teste gen&#233;tico n&#227;o foi inclu&#237;do&#44; pois n&#227;o &#233; ainda rotineiramente dispon&#237;vel no servi&#231;o&#46; Dados estat&#237;sticos foram apresentados como porcentagens e m&#233;dias&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0040" class="elsevierStylePara elsevierViewall">No total&#44; dos 309 pacientes com EB&#44; 31 foram exclu&#237;dos&#44; devido a dados incompletos&#46; No total de&#160;278&#160;pacientes inclu&#237;dos&#44; 147 &#40;53&#37;&#41; eram mulheres e 131 &#40;47&#37;&#41;&#44; 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Entre 11 e 20 anos de idade&#44; 29 &#40;10&#37;&#41; pacientes foram diagnosticados&#46; Entre 21 e 80 anos&#44; 52 &#40;19&#37;&#41; pacientes obtiveram diagn&#243;stico de EB&#44; enquanto somente um paciente masculino tinha 82 anos&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Em rela&#231;&#227;o &#224; idade atual &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#44; a m&#233;dia foi de 26 anos&#46; Para o c&#225;lculo&#44; a idade considerada no caso dos pacientes que foram &#224; &#243;bito foi a idade da morte&#46; Somente 40 &#40;14&#37;&#41; indiv&#237;duos tinham menos de 10 anos&#44; enquanto 92 &#40;33&#37;&#41; pacientes tinham entre 11 e 20 anos&#46; Na faixa et&#225;ria entre 21 e 80 anos&#44; havia 143 &#40;51&#37;&#41; pacientes&#44; enquanto tr&#234;s tinham mais de 81 anos&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">A m&#233;dia do tempo de seguimento foi de 9 anos&#44; exclu&#237;dos seis pacientes que compareceram somente para exame diagn&#243;stico e n&#227;o compareceram para seguimento no ambulat&#243;rio&#46; Para os pacientes falecidos&#44; foi considerada a data da &#250;ltima consulta antes de o &#243;bito acontecer&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Em rela&#231;&#227;o ao comprometimento extracut&#226;neo &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#44; 40 &#40;14&#37;&#41; pacientes tiveram diferentes graus de disfagia &#40;estenose de es&#244;fago&#41;&#46; Desses&#44; 25 &#40;62&#44;5&#37;&#41; s&#227;o EBDR&#44; 10 &#40;25&#37;&#41; s&#227;o EBDD&#44; dois &#40;5&#37;&#41; s&#227;o EBD pruriginosa&#44; dois &#40;5&#37;&#41; s&#227;o EBJ&#44; um &#40;2&#44;5&#37;&#41; &#233; EBS e nenhum &#233; EBK&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Doen&#231;as dent&#225;rias foram identificadas em 100 &#40;36&#37;&#41; pacientes&#44; dentre os quais 54 &#40;54&#37;&#41; s&#227;o EBDR&#44; 28 &#40;28&#37;&#41; s&#227;o EBDD&#44; 13 &#40;13&#37;&#41; s&#227;o EBS&#44; tr&#234;s &#40;3&#37;&#41; s&#227;o EBJ&#44; dois &#40;2&#37;&#41; s&#227;o EBK e nenhum &#233; EBD pruriginosa&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Desnutri&#231;&#227;o foi avaliada por meio do &#237;ndice de massa corporal &#40;IMC &#8804; 18&#41; e acometeu 35 &#40;13&#37;&#41; indiv&#237;duos&#46; Desses&#44; 24 &#40;68&#44;6&#37;&#41; s&#227;o EBDR&#44; seis &#40;17&#44;1&#37;&#41; s&#227;o EBDD&#44; tr&#234;s &#40;8&#44;5&#37;&#41; s&#227;o EBS&#44; um &#40;2&#44;9&#37;&#41; &#233; EBJ e um &#40;2&#44;9&#37;&#41; &#233; EBK&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Anemia foi achado frequente&#44; com 81 &#40;29&#37;&#41; pacientes acometidos&#59; seis &#40;2&#37;&#41; deles foram submetidos a transfus&#245;es sangu&#237;neas&#44; todos EBDR&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Acometimento ortop&#233;dico foi observado em 67&#160;&#40;24&#37;&#41; pacientes e aqueles com pseudosindactilia nas m&#227;os &#40;59 pacientes&#41; foram encaminhados ao ambulat&#243;rio de ortopedia&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Nevos da epiderm&#243;lise bolhosa &#40;nevos EB&#41; foram identificados em 47 &#40;17&#37;&#41; indiv&#237;duos&#44; no total de 90 nevos&#44; uma vez que um mesmo paciente apresentou de uma a cinco les&#245;es &#40;<a class="elsevierStyleCrossRef" href="#fig0030">fig&#46; 6A</a>&#41;&#46; Dez pacientes eram EBDD&#44; 29 eram EBDR&#44; dois eram EBJ&#44; cinco eram EBS e um era EBD pruriginosa&#46;</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Atresia de piloro foi identificada em uma paciente EBS com acometimento cut&#226;neo grave&#46; Distrofia muscular foi observada em um paciente EBS&#46; Cardiomiopatia dilatada foi identificada em um paciente EBK de 30 anos que perdeu seguimento e em um paciente EBDR&#44; que foi a &#243;bito aos 20 anos&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Altera&#231;&#245;es dermatol&#243;gicas n&#227;o relacionadas &#224; EB incluem dermatite seborreica &#40;1&#41;&#44; dermatite at&#243;pica &#40;1&#41;&#44; pseudot&#237;nea amiant&#225;cea &#40;1&#41;&#46; Foliculite decalvante foi identificada em dois indiv&#237;duos&#44; ambos com a forma distr&#243;fica de EB&#46; Alopecia cicatricial acometeu duas pacientes EBJ&#46; A <a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a> mostra outras doen&#231;as extracut&#226;neas encontradas nos pacientes dessa coorte&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">No processo de investiga&#231;&#227;o diagn&#243;stica&#44; 202 &#40;72&#44;6&#37;&#41; indiv&#237;duos foram submetidos ao total de 302 biopsias para exame histol&#243;gico&#46; Imunomapeamento foi realizado em 256 &#40;92&#37;&#41; pacientes&#44; com total de 359 exames realizados nesse per&#237;odo&#46; Nove realizaram somente biopsia&#44; 63 realizaram somente imunomapeamento&#44; 193 pacientes foram submetidos a ambos os exames e 13 n&#227;o fizeram nenhum&#46; A classifica&#231;&#227;o do tipo de EB dos 13 pacientes que n&#227;o realizaram nenhum exame levou em considera&#231;&#227;o hist&#243;ria familiar e quadro cl&#237;nico compat&#237;vel&#44; apesar de o diagn&#243;stico n&#227;o ter sido confirmado laboratorialmente&#46; Esses pacientes n&#227;o foram submetidos &#224; biopsia de pele ou imunomapeamento por quest&#245;es sociais &#40;indisponibilidade de retornar ao hospital&#41; ou por falta de consentimento dos respons&#225;veis ou dos pr&#243;prios pacientes &#40;cinco rec&#233;m&#8208;natos&#44; cinco crian&#231;as menores de 12 anos e tr&#234;s adultos&#44; idades 17&#44; 27 e 49 anos&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Durante o per&#237;odo de seguimento&#44; nove &#40;3&#44;2&#37;&#41; pacientes foram diagnosticados com 11 carcinomas espinocelulares &#40;CEC&#41;&#46; Um paciente EBJ apresentou tr&#234;s CEC &#40;um em cada membro inferior e um no dorso&#41;&#46; A localiza&#231;&#227;o do CEC &#40;<a class="elsevierStyleCrossRef" href="#fig0030">fig&#46; 6B</a>&#41; nos demais pacientes foi nos membros inferiores em seis &#40;um EBJ&#44; quatro EBDR e um EBDD&#41; e dorso em um paciente &#40;EBDR&#41;&#46; Em uma das pacientes EBDR&#44; o local do CEC &#233; desconhecido&#44; por falta de informa&#231;&#227;o nos registros m&#233;dicos&#46; Amputa&#231;&#227;o transtibial foi realizada em tr&#234;s pacientes &#40;dois homens EBDR aos 18 e aos 19 anos e uma mulher EBDD aos 27 anos&#41;&#46; Cinco &#40;55&#44;5&#37;&#41; apresentaram met&#225;stase e foram a &#243;bito&#44; dentre os quais tr&#234;s EBDR &#40;a idade do &#243;bito de dois foi aos 18 anos e de um foi aos 20 anos&#41;&#44; um EBDD &#40;28 anos&#41; e um EBJ &#40;57 anos&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">No total&#44; 11 pacientes foram a &#243;bito&#44; cinco EBDR &#40;18&#44; 18&#44; 20&#44; 22 e 24 anos&#41;&#44; cinco EBDD &#40;1&#44; 11&#44; 15&#44; 15&#44; 28 anos&#41; e um EBJ &#40;57 anos&#41;&#46; Causa de morte de cinco destes foi por complica&#231;&#245;es de CEC metast&#225;tico&#46; Tr&#234;s foram a &#243;bito em virtude de sepse por broncopneumonia &#40;dois EBDD&#44; ambos com 15 anos&#44; e um EBDR de 22 anos&#41;&#46; Um paciente EBDR de 24 anos teve broncoaspira&#231;&#227;o como causa de morte&#46; Duas crian&#231;as EBDD&#44; de 1 ano e de 11 anos&#44; foram a &#243;bito sem causa conhecida&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Pacientes que n&#227;o compareceram a consultas na dermatologia e em outras especialidades no HC&#8208;FMUSP h&#225; mais de dois anos foram considerados perda de seguimento&#46; No total&#44; 158 &#40;57&#37;&#41; pacientes tiveram data da &#250;ltima consulta antes de 31&#47;12&#47;2020&#46; Entre 2021 e 2022&#44; tr&#234;s pacientes foram a &#243;bito&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0120" class="elsevierStylePara elsevierViewall">Em nosso estudo de EB heredit&#225;ria&#44; n&#227;o observamos predile&#231;&#227;o por sexo&#59; o n&#250;mero de mulheres e homens acometidos foi semelhante&#44; conforme previamente descrito na literatura&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2&#44;17</span></a> A forma distr&#243;fica de EB foi a mais frequente &#40;73&#44;4&#37;&#41;&#44; propor&#231;&#227;o semelhante &#224; encontrada em estudo realizado no Ir&#227; &#40;75&#44;7&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> Estudos de outros pa&#237;ses descreveram frequ&#234;ncia menor de EBD&#44; como Canad&#225; &#40;35&#37;&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">18</span></a> Austr&#225;lia &#40;35&#37;&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a> Holanda<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a> com 34&#44;7&#37; &#40;EBDD 23&#44;1&#37; e EBDR 11&#44;4&#37;&#41;&#44; Alemanha &#40;32&#44;5&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a> e &#205;ndia &#40;17&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">22</span></a> A predomin&#226;ncia de formas mais graves de EB em nosso estudo se deve&#44; em parte&#44; a dificuldades de acesso a atendimento m&#233;dico especializado<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">23</span></a> em nosso pa&#237;s e subdiagn&#243;stico das formas mais localizadas de EBS e ao fato de o HC&#8208;FMUSP ser hospital terci&#225;rio&#44; refer&#234;ncia nacional no atendimento de paciente com EB&#44; e atender casos de mais alta complexidade&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">No presente estudo&#44; EBS acometeu 16&#44;5&#37; dos pacientes&#44; enquanto EBJ 9&#44;4&#37; dos pacientes e EBK 1&#44;1&#37;&#46; A frequ&#234;ncia de EBJ no estudo do Ir&#227;&#44;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> Canad&#225;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">18</span></a> e Austr&#225;lia<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a> foi de 11&#37;&#59; na Holanda<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a> de 18&#44;8&#37; e na Alemanha&#44;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a> 17&#44;1&#37;&#46; J&#225; EBK&#44; 3&#37; no Ir&#227;&#44;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> 0&#44;3&#37; na Austr&#225;lia&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a> 0&#44;9&#37; na Holanda<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a> e 0&#44;5&#37; na Alemanha&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a> Em ambos os tipos de EB&#44; as porcentagens encontradas em nosso estudo foram semelhantes&#46; Em rela&#231;&#227;o &#224; EBS&#44; a frequ&#234;ncia encontrada &#233; menor do que a descrita na literatura&#44; uma vez que a popula&#231;&#227;o estudada adv&#233;m de hospital terci&#225;rio&#46; Segundo estudo epidemiol&#243;gico de 2021<span class="elsevierStyleHsp" style=""></span>da Holanda&#44;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a> EBS foi diagnosticada em 45&#44;7&#37;&#46; Nessa coorte holandesa&#44; 90&#44;5&#37; dos pacientes tiveram diagn&#243;stico geneticamente confirmado&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a> Dados epidemiol&#243;gicos de 1&#46;779 pacientes da Alemanha&#44; publicados em 2022&#44;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a> mostraram 39&#44;3&#37; &#40;700&#41; de pacientes EBS&#46; Este estudo incluiu pacientes de hospitais terci&#225;rios&#44; ambulat&#243;rios de Dermatologia&#44; laborat&#243;rios que realizaram o diagn&#243;stico e de organiza&#231;&#245;es de pacientes&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">A m&#233;dia da idade atual encontrada em nosso estudo foi de 26 anos&#44; e somente 40 &#40;14&#37;&#41; indiv&#237;duos tinham menos de 10 anos&#46; O elevado n&#250;mero de pacientes na idade puberal&#44; ou seja&#44; acima de 11 anos&#44; permite inferir aumento na expectativa de vida e reflete a melhora nos cuidados multidisciplinares&#44; principalmente em rela&#231;&#227;o &#224; nutri&#231;&#227;o&#44; infec&#231;&#227;o e manejo da dor&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Quanto &#224; consanguinidade&#44; apenas 31 pacientes &#40;11&#37;&#41; declararam sua ocorr&#234;nci&#44; e a EBDR foi o tipo que mais acometeu a popula&#231;&#227;o em estudo &#40;25&#44;8&#37;&#41;&#46; Como a maioria dos pacientes n&#227;o realizou teste gen&#233;tico&#44; o diagn&#243;stico n&#227;o foi confirmado por esse m&#233;todo&#46; Na literatura&#44; &#233; relatado que o n&#250;mero de pacientes com forma autoss&#244;mica recessiva de EB pode estar associado &#224;s comunidades com altas taxas de consanguinidade parental&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">24</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">As queixas mais comuns dos pacientes foram altera&#231;&#245;es dent&#225;rias &#40;36&#37;&#41;&#44; seguido por anemia &#40;29&#37;&#41; e doen&#231;as ortop&#233;dicas &#40;24&#37;&#41;&#46; No estudo do Ir&#227;&#44; foi disfagia seguido de altera&#231;&#245;es dent&#225;rias&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> Esses achados dent&#225;rios se devem na EBJ &#224; hipoplasia do esmalte dent&#225;rio e presen&#231;a de depress&#245;es puntiformes &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3A</a>&#41;&#44; que s&#227;o achados cl&#237;nicos patognom&#244;nicos nessa forma de EB&#46; Essas altera&#231;&#245;es acarretam perda precoce de dentes e c&#225;ries&#46; Na EBDR&#44; microstomia e anquiloglossia s&#227;o observadas e dificultam a higiene dental di&#225;ria&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">25</span></a> Deve&#8208;se sempre levar em considera&#231;&#227;o os cuidados prec&#225;rios de higiene bucal na maioria dos doentes com EB &#40;<a class="elsevierStyleCrossRef" href="#fig0025">fig&#46; 5B</a>&#41;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Pseudosindactilia das m&#227;os &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2B</a>&#41; e dos p&#233;s &#233; complica&#231;&#227;o m&#250;sculo&#8208;esquel&#233;tica que ocorre principalmente na EBDR&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">25</span></a> O uso de luvas ou curativos para manter os quirod&#225;ctilos separados &#233; aconselhado nos pacientes com EB distr&#243;fica&#46; Em 2011&#44; o grupo de ortopedia especializado em m&#227;os do HC&#8208;FMUSP&#44; em conjunto com a equipe de Dermatologia pedi&#225;trica&#44; publicou dados de 59 pacientes com EB e deformidades nas m&#227;os&#44; dos quais 25 foram submetidos &#224; cirurgia&#44; com taxa elevada de reopera&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a> Estudo de 2019 do grupo da China<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">27</span></a> relatou 11 pacientes EBDR submetidos &#224; cirurgia e com seguimento por dois anos&#44; dos quais nove apresentaram perda da funcionalidade das m&#227;os pelo reestreitamento dos espa&#231;os interdigitais&#44; com ades&#227;o de d&#237;gitos e flex&#227;o de articula&#231;&#245;es metacarpofalangeanas e interfalangeanas&#46; Os outros dois pacientes foram reoperados ap&#243;s um ano em virtude de recidiva&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">O Registro Nacional de EB &#40;NEBR&#41; dos Estados Unidos com casu&#237;stica de 3&#46;280 pacientes acompanhados por per&#237;odo de 16 anos &#40;1986&#8208;2002&#41;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">28&#44;29</span></a> permanece como o maior estudo epidemiol&#243;gico sobre EB&#46; Demonstrou que a frequ&#234;ncia de estenose de es&#244;fago &#233; de 79&#44;1&#37; em pacientes com EBDR grave&#44; 37&#44;2&#37; para EBDR intermedi&#225;ria e 14&#44;3&#37; em EBJ&#44; com frequ&#234;ncias menores nos demais subtipos de EB&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">28</span></a> Em nosso estudo&#44; estenose de es&#244;fago foi identificada em 14&#37; do total de indiv&#237;duos&#59; 28&#44;4&#37; e 7&#44;7&#37; foram as frequ&#234;ncias observadas em pacientes com EBDR e EBJ&#44; respectivamente&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Em 2005&#44; foi publicado um trabalho envolvendo a Gastroenterologia e a Dermatologia Pedi&#225;trica do HC&#8208;FMUSP&#44;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a> que relatou 19 pacientes com formas graves de EB &#40;EBD e EBJ&#41; atendidos entre janeiro de 1999 e abril de 2001&#46; V&#244;mitos e disfagia foram referidos por 16 &#40;84&#44;2&#37;&#41; casos&#44; engasgos por 14 &#40;73&#44;7&#37;&#41; e constipa&#231;&#227;o intestinal por 14 &#40;73&#44;7&#37;&#41; pacientes&#46; Anemia acometeu todos os casos&#46; Em rela&#231;&#227;o aos aspectos nutricionais&#44; 12 &#40;63&#44;1&#37;&#41; apresentavam peso e estatura inferiores ao percentil 2&#44;5&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a> No presente estudo&#44; desnutri&#231;&#227;o acometeu 35 &#40;12&#37;&#41;&#46; O menor percentual encontrado est&#225; associado &#224; metodologia deste trabalho&#44; que incluiu todas as formas de EB&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Nevo EB &#233; descrito como nevo adquirido&#44; eruptivo&#44; assim&#233;trico e acomete cerca de 14&#37; dos portadores de EB&#44; em suas v&#225;rias formas cl&#237;nicas&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">31</span></a> Os nevos EB geralmente ocorrem em s&#237;tios de bolhas pr&#233;vias e podem involuir espontaneamente&#46; Entretanto&#44; teoricamente o melanoma poderia surgir a partir do nevo EB ou de les&#245;es pigmentadas que mimetizam clinicamente o nevo EB&#46; Dessa maneira&#44; qualquer mudan&#231;a morfol&#243;gica no nevo EB&#44; em especial o surgimento de nodula&#231;&#227;o ou ulcera&#231;&#227;o&#44; aponta para a realiza&#231;&#227;o de estudo histopatol&#243;gico&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">32</span></a> Neste estudo&#44; nevos EB foram identificados em 17&#37; dos pacientes&#46; Em 2014&#44; a equipe de Dermatologia Pedi&#225;trica do HC&#8208;FMUSP descreveu 13 pacientes EBD com nevos EB&#44; cinco dos quais foram biopsiados em virtude das caracter&#237;sticas dermatosc&#243;picas at&#237;picas dos nevos&#46; Dois corresponderam a nevo at&#237;pico ou prolifera&#231;&#227;o lentiginosa at&#237;pica &#224; avalia&#231;&#227;o histopatol&#243;gica&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a> Em 2005&#44; um grupo da &#193;ustria<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">33</span></a> descreveu caracter&#237;sticas dermatosc&#243;picas de 23 nevos EB de 11 pacientes&#44; com crit&#233;rios associados a melanoma encontrados&#44; como padr&#227;o multicomponentes &#40;20 de 23&#41;&#44; rede pigmentada at&#237;pica &#40;17 de 23&#41;&#44; gl&#243;bulos e pontos irregulares &#40;16 de 23&#41;&#44; pigmenta&#231;&#227;o irregular &#40;22 de 23&#41; e padr&#227;o vascular at&#237;pico &#40;7 de 23&#41;&#46; O mesmo grupo indicou avalia&#231;&#227;o histol&#243;gica de les&#245;es altamente suspeitas&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">A atresia de piloro associada &#224; EB foi encontrada em uma paciente feminina EBS de 28 anos e com acometimento cut&#226;neo extenso&#46; Trata&#8208;se de um subtipo distinto&#44; que geralmente ocorre em fen&#243;tipos graves de EB&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">34</span></a> Quando ocorre concomitantemente &#224; EBS grave&#44; est&#225; associada &#224; muta&#231;&#227;o no gene da plectina &#40;PLEC&#41;&#44; prote&#237;na formadora do hemidesmossoma&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a> O diagn&#243;stico gen&#233;tico da paciente em quest&#227;o ainda n&#227;o foi realizado&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Um paciente masculino EBS de 22 anos com diagn&#243;stico gen&#233;tico de muta&#231;&#227;o no gene PLEC apresentou distrofia muscular&#44; como j&#225; citado na literatura&#46; Pode estar presente ao nascimento ou nos primeiros dias de vida nas crian&#231;as com doen&#231;a cut&#226;nea grave&#44;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">35</span></a> ou pode se estabelecer de forma insidiosa no final da inf&#226;ncia ou na vida adulta&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">25</span></a> No estudo holand&#234;s de 2021&#44;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a> dois pacientes com EBS e distrofia muscular morreram com idades de 43&#44;7 anos e 46 anos por fal&#234;ncia card&#237;aca&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">O maior risco de cardiomiopatia dilatada &#233; visto entre pacientes EBDR grave&#44; com risco cumulativo de 4&#44;51&#37; aos 20 anos de idade&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">36</span></a> Dentre os pacientes inclu&#237;dos neste estudo&#44; cardiomiopatia acometeu um paciente EBDR&#44; que foi a &#243;bito aos 20 anos&#44; e um paciente EBK de 30 anos&#44; que perdeu seguimento&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Durante o per&#237;odo avaliado&#44; foram realizadas 302 biopsias de pele e 359 imunomapeamentos&#46; Alguns exames foram repetidos em virtude de laudos inconclusivos&#44; pois as bolhas biopsiadas estavam em processo de reepiteliza&#231;&#227;o ou a clivagem estava ausente&#46; O exame histol&#243;gico da biopsia de pele deve ser realizado em uma bolha &#237;ntegra &#40;pele acometida&#41; recente&#46; A clivagem &#233; intraepid&#233;rmica nos casos de EBS e subepid&#233;rmica na EBJ e EBD&#44; n&#227;o sendo poss&#237;vel diferenciar essas duas formas por meio da histopatologia com colora&#231;&#227;o de rotina&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">10</span></a> Na EBK&#44; o plano de clivagem &#233; vari&#225;vel&#46; J&#225; o imunomapeamento pode ser realizado em amostra de pele s&#227; com ves&#237;cula induzida ou em ves&#237;cula recente e idealmente pequena&#44; para que n&#227;o se rompa no ato da biopsia&#46; Trata&#8208;se de t&#233;cnica de imunofluoresc&#234;ncia e tem a vantagem de possibilitar a visualiza&#231;&#227;o do plano de clivagem&#44; permitindo diferencia&#231;&#227;o entre as formas simples&#44; juncional e distr&#243;fica&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">10</span></a> Os marcadores utilizados no Departamento de Dermatologia do HC&#8208;FMUSP s&#227;o&#58; ant&#237;geno do penfigoide bolhoso &#40;marcador de hemidesmossoma&#41;&#44; anticorpo antilaminina 5 &#40;l&#226;mina l&#250;cida&#41;&#44; anticorpo anticol&#225;geno IV &#40;l&#226;mina densa&#41; e anticorpo anticol&#225;geno VII &#40;subl&#226;mina densa e fibrilas de ancoragem&#41;&#46; Na EBS&#44; a clivagem ocorre na camada basal&#46; Na EBJ&#44; o n&#237;vel de clivagem ocorre na l&#226;mina l&#250;cida&#44; enquanto na EBD ocorre na subl&#226;mina densa &#40;<a class="elsevierStyleCrossRef" href="#fig0035">fig&#46; 7</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">10</span></a> Na EBDR&#44; h&#225; aus&#234;ncia ou diminui&#231;&#227;o acentuada da fluoresc&#234;ncia com o col&#225;geno VII&#46; Em 2021&#44; um estudo da &#205;ndia<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">37</span></a> mostrou a utilidade do imunomapeamento como m&#233;todo diagn&#243;stico&#44; frente &#224; indisponibilidade de microscopia eletr&#244;nica e de testes gen&#233;ticos&#46; Diagn&#243;stico de 104 EBS&#44; 28 EBJ e de 26 EBD foi realizado com taxa de concord&#226;ncia de 41&#44;3&#37;&#44; com maiores taxas nos casos de EBS&#46;</p><elsevierMultimedia ident="fig0035"></elsevierMultimedia><p id="par0185" class="elsevierStylePara elsevierViewall">A pesquisa das muta&#231;&#245;es nos genes associados &#224; EB &#233; padr&#227;o ouro para defini&#231;&#227;o do subtipo de EB e evitaria a realiza&#231;&#227;o de biopsia e imunomapeamento&#46; Tem sido realizada de maneira mais r&#225;pida e menos custosa&#44; com maiores taxas de detec&#231;&#227;o mutacional&#44; devido aos avan&#231;os na tecnologia de sequenciamento&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">38</span></a> No nosso servi&#231;o&#44; teste gen&#233;tico vem sendo realizado no &#226;mbito da pesquisa&#44; por&#233;m ainda n&#227;o est&#225; amplamente dispon&#237;vel na pr&#225;tica ambulatorial por n&#227;o ser exame coberto pelo SUS&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Em algumas formas de EB&#44; especialmente na EBDR&#44; h&#225; risco aumentado de CEC no final da adolesc&#234;ncia e in&#237;cio da vida adulta&#46; Estudo recente do grupo da Austr&#225;lia e da Nova Zel&#226;ndia<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">39</span></a> mostrou 16 pacientes EBDR com 161 CEC prim&#225;rios&#44; com m&#233;dia de 10 CEC por indiv&#237;duo&#46; Desses tumores&#44; 70&#37; surgiram nas m&#227;os e nos p&#233;s&#44; principalmente em &#225;reas de &#250;lceras cr&#244;nicas e de feridas que n&#227;o cicatrizavam&#46; Met&#225;stase foi detectada em 11 &#40;68&#44;7&#37;&#41; desses pacientes&#46; Amputa&#231;&#227;o parcial do membro foi realizado em sete casos&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">39</span></a> Dos nove pacientes diagnosticados com CEC em nosso estudo&#44; sete &#40;77&#44;7&#37;&#41; apresentaram tumor nos membros inferiores e cinco &#40;55&#44;5&#37;&#41; tiveram met&#225;stase&#46; Apenas um indiv&#237;duo EBJ apresentou mais de um CEC &#40;tr&#234;s tumores&#41;&#44; enquanto tr&#234;s pacientes foram submetidos &#224; amputa&#231;&#227;o transtibial&#46; CEC &#233; a principal causa de morte nesse grupo de pacientes&#44; e o risco cumulativo de morte por met&#225;stase &#233; de 38&#44;7&#37; aos 35 anos e de 78&#44;8&#37; aos 55 anos de idade&#46; A maioria dos pacientes com EBDR morrem de CEC metast&#225;tico no per&#237;odo de cinco anos ap&#243;s o diagn&#243;stico&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">29</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">O baixo n&#250;mero de &#243;bitos &#40;11&#41; identificado neste estudo pode estar relacionado aos cuidados multidisciplinares dirigidos aos pacientes&#46; Por&#233;m&#44; h&#225; o vi&#233;s de informa&#231;&#227;o&#44; pois esse dado somente &#233; registrado no prontu&#225;rio quando o &#243;bito ocorre em algum hospital do complexo HC&#8208;FMUSP&#46; Informa&#231;&#245;es sobre &#243;bitos que ocorrem em casa ou em outros hospitais n&#227;o est&#227;o dispon&#237;veis&#44; pela falta de um banco de dados unificado nacional&#46; Cinco pacientes EBDR foram a &#243;bito com m&#233;dia de idade de 20&#44;4 anos&#44; enquanto a m&#233;dia de idade de &#243;bito de cinco pacientes EBDD foi de 14 anos&#46; A idade m&#233;dia de vida em pacientes com EBD segundo estudo recente na Holanda &#233; de 32&#44;5 anos&#46; Em EBDR&#44; esse valor &#233; de 28&#44;8 anos e em EBDD de 33&#44;3 anos&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">Quanto &#224;s principais limita&#231;&#245;es&#44; por se tratar de um estudo retrospectivo com longo per&#237;odo de avalia&#231;&#227;o &#40;2000&#8208;2022&#41;&#44; houve falta de informa&#231;&#245;es em alguns prontu&#225;rios m&#233;dicos e perda de seguimento de pacientes&#46; Outro ponto &#233; a indisponibilidade de testes gen&#233;ticos de rotina para os pacientes com EB em nosso servi&#231;o e no sistema p&#250;blico de sa&#250;de&#44; o que pode dificultar a classifica&#231;&#227;o da forma cl&#237;nica de EB&#46; Apesar desse estudo n&#227;o ser multic&#234;ntrico&#44; representa o primeiro trabalho com dados epidemiol&#243;gicos de epiderm&#243;lise bolhosa heredit&#225;ria na popula&#231;&#227;o brasileira&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">No Brasil&#44; o HC&#8208;FMUSP &#233; um dos poucos centros de refer&#234;ncia multidisciplinar especializados em EB&#46; O acesso a esses servi&#231;os escassos &#233; dif&#237;cil&#44; uma vez que depende do encaminhamento das unidades b&#225;sicas de sa&#250;de&#44; que muitas vezes s&#227;o distantes e localizam&#8208;se at&#233; mesmo em outros Estados&#44; de forma que o nosso servi&#231;o atende pacientes de todo o pa&#237;s&#46; Outro problema cr&#237;tico &#233; a falta de suprimento de necessidades b&#225;sicas dos pacientes&#44; como curativos n&#227;o&#8208;aderentes e at&#233; mesmo curativos simples&#46; Muitas vezes o paciente de EB n&#227;o &#233; diagnosticado e tratado adequadamente&#46; H&#225; subdiagn&#243;stico e os poucos dados epidemiol&#243;gicos que s&#227;o publicados acabam n&#227;o refletindo a realidade da incid&#234;ncia e preval&#234;ncia de doen&#231;as raras&#44; como a EB&#46; Semelhante ao que ocorre no Canad&#225;&#44; n&#227;o h&#225; centros especializados no cuidado de adultos com EB e esses continuam sendo atendidos em ambulat&#243;rios pedi&#225;tricos&#46; Quest&#245;es da vida adulta&#44; como sexualidade&#44; emprego&#44; independ&#234;ncia e manejo de c&#226;ncer de pele s&#227;o tratados com limita&#231;&#245;es&#44; o que torna necess&#225;rio o encaminhamento a outras especialidades&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">40</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#227;o</span><p id="par0210" class="elsevierStylePara elsevierViewall">Em doen&#231;as raras como a EB&#44; dados epidemiol&#243;gicos confi&#225;veis permitem a identifica&#231;&#227;o de tend&#234;ncias epidemiol&#243;gicas&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">14</span></a> Esse estudo demonstra a predomin&#226;ncia de formas mais graves na nossa casu&#237;stica &#40;EB distr&#243;fica&#41;&#44; provavelmente por se tratar de um hospital terci&#225;rio&#44; e ressalta a necessidade de cuidado multidisciplinar&#44; principalmente em rela&#231;&#227;o &#224;s comorbidades e &#224;s complica&#231;&#245;es dos pacientes&#44; como anemia&#44; doen&#231;as dent&#225;rias&#44; ortop&#233;dicas e do trato gastrointestinal e carcinoma espinocelular&#46; No Brasil&#44; h&#225; a necessidade de cria&#231;&#227;o de banco de dados que unifique informa&#231;&#245;es cl&#237;nicas de toda a popula&#231;&#227;o&#44; a fim de identificar essas tend&#234;ncias e permitir melhor direcionamento das pol&#237;ticas de sa&#250;de &#40;verbas e financiamento&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Suporte financeiro</span><p id="par0215" class="elsevierStylePara elsevierViewall">Estudo patrocinado pela Fundo de Apoio &#224; Dermatologia do Estado de S&#227;o Paulo &#40;FUNADERSP&#41; &#91;PROJETO 105&#8208;2022&#93; e pelo Departamento de Dermatologia do Hospital das Cl&#237;nicas da Universidade de S&#227;o Paulo&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Contribui&#231;&#227;o dos autores</span><p id="par0220" class="elsevierStylePara elsevierViewall">Chan I&#46; Thien&#58; concep&#231;&#227;o e planejamento do estudo&#59; coleta de dados ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; an&#225;lise estat&#237;stica&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Vanessa Rolim Bessa&#58; Coleta de dados&#44; ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; an&#225;lise estat&#237;stica&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Isadora Zago Miotto&#58; Coleta de dados&#44; ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; an&#225;lise estat&#237;stica&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Luciana Paula Samorano&#58; Concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Maria Cec&#237;lia Rivitti Machado&#58; Concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Zilda Najjar Prado de Oliveira&#58; Concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#59; an&#225;lise estat&#237;stica&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflito de interesses</span><p id="par0250" 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">Epiderm&#243;lise bolhosa &#40;EB&#41; &#233; um grupo de doen&#231;as heredit&#225;rias raras&#44; caracterizadas por fragilidade da pele e mucosas&#46; Dados epidemiol&#243;gicos de EB no Brasil s&#227;o escassos&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Descrever aspectos epidemiol&#243;gicos de pacientes com EB diagnosticados no Departamento de Dermatologia de um hospital terci&#225;rio&#44; de 2000 at&#233; 2022&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudo observacional e retrospectivo foi conduzido por meio da an&#225;lise de prontu&#225;rios&#46; Dados avaliados inclu&#237;ram forma cl&#237;nica&#44; sexo&#44; hist&#243;ria familiar&#44; consanguinidade&#44; idade ao diagn&#243;stico&#44; idade atual&#44; tempo de seguimento&#44; comorbidades&#44; exame histopatol&#243;gico e imunomapeamento&#44; presen&#231;a de nevos EB e de carcinomas espinocelulares &#40;CEC&#41;&#44; causa e idade da morte&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Dos 309 pacientes com EB heredit&#225;ria&#44; 278 foram inclu&#237;dos&#46; O tipo mais comum foi EB distr&#243;fica &#40;EBD&#41;&#44; com 73&#37; &#40;28&#44;4&#37; EBD dominante&#44; 31&#44;7&#37; EBD recessiva e 12&#44;9&#37; EBD pruriginosa&#41;&#46; Outros tipos foram juncional com 9&#44;4&#37;&#44; simples com 16&#44;5&#37; e Kindler com 1&#44;1&#37;&#46; Mulheres corresponderam a 53&#37; e homens a 47&#37;&#46; Hist&#243;ria familiar foi encontrada em 35&#37; e consanguinidade em 11&#37;&#46; A m&#233;dia de idade ao diagn&#243;stico foi de 10&#44;8 anos&#44; e da idade atual foi de 26 anos&#46; A m&#233;dia do tempo de seguimento foi de nove anos&#46; Estenose de es&#244;fago acometeu 14&#37;&#44; doen&#231;as dent&#225;rias acometeram 36&#37;&#44; desnutri&#231;&#227;o 13&#37; e anemia 29&#37; dos indiv&#237;duos&#46; Durante a investiga&#231;&#227;o diagn&#243;stica&#44; 72&#44;6&#37; realizaram exame histopatol&#243;gico e 92&#37; fizeram imunomapeamento&#46; Nevos EB foram identificados em 17&#37;&#46; Nove pacientes tiveram CEC&#46; Onze foram a &#243;bito&#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">Dados insuficientes nos prontu&#225;rios&#44; perda de seguimento e indisponibilidade do teste gen&#233;tico&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#245;es</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Neste estudo&#44; predominou EB distr&#243;fica e ressaltou&#8208;se a necessidade de cuidado multidisciplinar das comorbidades e das complica&#231;&#245;es&#46;</p></span>"
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                  \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  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sexo</th><th class="td" title="\n
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                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fem&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">Total&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">Sim&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">N&#227;o&nbsp;\t\t\t\t\t\t\n
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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">N&#227;o informado&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">Total&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">Sim&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">N&#227;o&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">Total&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">EBS&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">23&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">23&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">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">14&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">24&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&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">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">5&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">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">46&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">EBJ&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">12&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&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">26&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&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&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&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">26&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3522980.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Distribui&#231;&#227;o do tipo de epiderm&#243;lise bolhosa em rela&#231;&#227;o ao sexo&#44; ao hist&#243;rico familiar e &#224; consanguinidade</p>"
        ]
      ]
      8 => 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:1 [
          "tablatextoimagen" => array:2 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Idade ao diagn&#243;stico</th></tr><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">0 a 1 ano&nbsp;\t\t\t\t\t\t\n
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                  \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">11 a 20&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">21 a 30&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">31 a 40&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">41 a 50&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">51 a 60&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">61 a 70&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">71 a 80&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">81 a 90&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">Total&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></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">EBS&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">20&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&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&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&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&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&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&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&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&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&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">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">16&#44;5&#37;&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">EBJ&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&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&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&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&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&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&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&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&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&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&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">26&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;4&#37;&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">EBDD&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">24&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&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&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&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&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&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&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&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&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&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">79&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">28&#44;4&#37;&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">EBDR&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">38&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&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&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&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&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&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&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&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&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&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">88&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">31&#44;7&#37;&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">EBD pruriginosa&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&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">5&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">5&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">5&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&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&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&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">4&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&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&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">36&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">12&#44;9&#37;&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">EBK&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&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&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&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&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&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&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&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&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&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&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&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;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">93&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">103&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&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&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&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">12&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">5&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">5&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&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&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">278&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></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3522979.png"
              ]
            ]
            1 => 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  " colspan="13" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Idade atual &#40;ou do &#243;bito&#41;</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="" 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
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                  \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">0 a 10&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">11 a 20&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">21 a 30&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">31 a 40&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">41 a 50&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">51 a 60&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">61 a 70&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">71 a 80&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">81 a 90&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">Total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \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-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">EBS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \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
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                  \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&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">15&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">5&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&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">1&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&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&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&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">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">16&#44;5&#37;&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">EBJ&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">6&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&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&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&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&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&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&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&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&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">26&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;4&#37;&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">EBDD&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">13&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">28&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">15&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&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">EBD pruriginosa&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3522982.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Distribui&#231;&#227;o do tipo de epiderm&#243;lise bolhosa quanto &#224; idade ao diagn&#243;stico e quanto &#224; idade atual&#46; No caso de pacientes que foram a &#243;bito&#44; foi considerada a idade da morte</p>"
        ]
      ]
      9 => 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 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Comorbidades</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
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                  \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">Estenose de es&#244;fago&nbsp;\t\t\t\t\t\t\n
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                  \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">Altera&#231;&#227;o dent&#225;ria&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">Desnutri&#231;&#227;o&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">Anemia&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" scope="col" style="border-bottom: 2px solid black">Transfus&#227;o sangu&#237;nea&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">Altera&#231;&#227;o ortop&#233;dica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Miopia &#40;2&#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"><span class="elsevierStyleHsp" style=""></span>Stafiloma da m&#225;cula &#40;1&#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
                  \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"><span class="elsevierStyleItalic">Gastroenterol&#243;gicas</span>&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"><span class="elsevierStyleHsp" style=""></span>Estenose de es&#244;fago &#40;40&#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">Megac&#243;lon &#40;1&#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">S&#237;ndrome disp&#233;ptica &#40;3&#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"><span class="elsevierStyleHsp" style=""></span>Doen&#231;a do refluxo gastroesof&#225;gico &#40;3&#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">Constipa&#231;&#227;o &#40;7&#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></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"><span class="elsevierStyleItalic">Otorrinolaringol&#243;gicas</span>&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"><span class="elsevierStyleHsp" style=""></span>Otite &#40;3&#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">Rouquid&#227;o &#40;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">Discinesia far&#237;ngea &#40;1&#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"><span class="elsevierStyleHsp" style=""></span>Hipoacusia &#40;1&#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">Laringomal&#225;cia &#40;1&#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">Tumor do seio maxilar direito &#40;1&#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"><span class="elsevierStyleHsp" style=""></span>S&#237;ndrome da apneia e da hipopneia obstrutivas do sono &#40;1&#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
                  \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"><span class="elsevierStyleItalic">Ortop&#233;dicas</span>&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"><span class="elsevierStyleHsp" style=""></span>Pseudosindactilia &#40;56&#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">Malforma&#231;&#227;o &#243;ssea &#40;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">Osteomielite &#40;1&#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"><span class="elsevierStyleHsp" style=""></span>Deformidade articular &#40;1&#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">Assimetria de membros inferiores &#40;1&#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></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"><span class="elsevierStyleItalic">Endocrinol&#243;gicas</span>&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"><span class="elsevierStyleHsp" style=""></span>Hipotireoidismo &#40;8&#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">Diabete <span class="elsevierStyleItalic">mellitus</span> &#40;5&#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">Baixa estatura &#40;2&#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"><span class="elsevierStyleHsp" style=""></span>Osteoporose &#40;3&#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">Puberdade tardia &#40;1&#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">Puberdade precoce &#40;1&#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"><span class="elsevierStyleHsp" style=""></span>Diabete <span class="elsevierStyleItalic">mellitus</span> insulinodependente &#40;1&#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">N&#243;dulo tireoideano &#40;1&#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></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"><span class="elsevierStyleItalic">Hematol&#243;gicas</span>&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"><span class="elsevierStyleHsp" style=""></span>Anemia &#40;82&#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">Tra&#231;o falc&#234;mico &#40;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">Defici&#234;ncia de G&#8208;6&#8208;PD &#40;1&#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"><span class="elsevierStyleHsp" style=""></span>Mieloma m&#250;ltiplo &#40;1&#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">P&#250;rpura trombocitop&#234;nica idiop&#225;tica &#40;1&#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></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"><span class="elsevierStyleItalic">Psiqui&#225;tricas</span>&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"><span class="elsevierStyleHsp" style=""></span>Depress&#227;o &#40;1&#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">Idea&#231;&#227;o suicida &#40;1&#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">S&#237;ndrome do p&#226;nico &#40;1&#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"><span class="elsevierStyleItalic">Pneumol&#243;gicas</span>&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"><span class="elsevierStyleHsp" style=""></span>Asma &#40;3&#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">Rinite al&#233;rgica &#40;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">Estenose de traqueia &#40;1&#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"><span class="elsevierStyleItalic">Cardiol&#243;gicas</span>&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"><span class="elsevierStyleHsp" style=""></span>Hipertens&#227;o arterial &#40;13&#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">Cardiomiopatia dilatada &#40;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">Doen&#231;a de Chagas &#40;1&#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"><span class="elsevierStyleHsp" style=""></span>Angina &#40;1&#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">Cardiopatia &#40;CIA&#44; estenose a&#243;rtica e pulmonar&#41; &#40;1&#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></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"><span class="elsevierStyleItalic">Urol&#243;gicas</span>&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"><span class="elsevierStyleHsp" style=""></span>Infec&#231;&#227;o urin&#225;ria &#40;3&#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">Criptorquidismo &#40;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">Estenose uretral &#40;1&#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"><span class="elsevierStyleItalic">Nefrol&#243;gicas</span>&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"><span class="elsevierStyleHsp" style=""></span>Nefropatia &#40;1&#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">Nefrite por IgA &#40;1&#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></tr></tbody></table>
                  """
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          "pt" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Outras manifesta&#231;&#245;es extracut&#226;neas encontradas nos pacientes deste estudo&#44; com o n&#250;mero de indiv&#237;duos acometidos entre par&#234;nteses</p>"
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                    0 => array:2 [
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Has"
                            1 => "J&#46;W&#46; Bauer"
                            2 => "C&#46; Bodemer"
                            3 => "M&#46;C&#46; Bolling"
                            4 => "L&#46; Bruckner-Tuderman"
                            5 => "A&#46; Diem"
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                        ]
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                      "Revista" => array:5 [
                        "tituloSerie" => "Br J Dermatol&#46;"
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                        "paginaFinal" => "627"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Bardhan"
                            1 => "L&#46; Bruckner-Tuderman"
                            2 => "I&#46;L&#46;C&#46; Chapple"
                            3 => "J&#46;D&#46; Fine"
                            4 => "N&#46; Harper"
                            5 => "C&#46; Has"
                          ]
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                  ]
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                    0 => array:2 [
                      "doi" => "10.1038/s41572-020-0210-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Rev Dis Primers&#46;"
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                        "volumen" => "6"
                        "paginaInicial" => "78"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An overview of the genetic basis of epidermolysis bullosa in Brazil&#58; discovery of novel and recurrent disease&#8208;causing variants"
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                          "etal" => false
                          "autores" => array:6 [
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                            1 => "J&#46;T&#46; Santin"
                            2 => "J&#46;A&#46; Frantz"
                            3 => "M&#46;J&#46;R&#46; Doriqui"
                            4 => "A&#46;E&#46; Kiszewski"
                            5 => "L&#46; Schuler-Faccini"
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                        "tituloSerie" => "Clin Genet&#46;"
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                        "paginaFinal" => "569"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Epidermolysis bullosa nevi&#58; clinical&#44; dermatoscopical and histological features in a case of recessive dystrofic form"
                      "autores" => array:1 [
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                            0 => "J&#46;N&#46; Melo"
                            1 => "P&#46;Y&#46; Teruya"
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                            3 => "N&#46;S&#46; Valente"
                            4 => "M&#46;N&#46; Sotto"
                            5 => "Z&#46;N&#46; Oliveira"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/s0365-05962011000400017"
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                        "volumen" => "86"
                        "paginaInicial" => "743"
                        "paginaFinal" => "746"
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                          0 => array:2 [
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                      "titulo" => "Underrecognition of epidermolysis bullosa pruriginosa"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;C&#46; Cha"
                            1 => "L&#46;P&#46; Samorano"
                            2 => "F&#46;M&#46; Dacache"
                            3 => "M&#46;C&#46; Rivitti-Machado"
                            4 => "Z&#46;N&#46;P&#46; de Oliveira"
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                  "host" => array:1 [
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                        "volumen" => "13"
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                        "paginaFinal" => "1038"
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                      "autores" => array:1 [
                        0 => array:2 [
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                            0 => "J&#46;D&#46; Fernandes"
                            1 => "M&#46;C&#46; Rivitti-Machado"
                            2 => "J&#46; Nakano"
                            3 => "B&#46; de Oliveira Rocha"
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                  "host" => array:1 [
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                      "titulo" => "Gene panel for the diagnosis of epidermolysis bullosa&#58; proposal for a viable and efficient approach"
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                          "etal" => false
                          "autores" => array:6 [
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                            2 => "J&#46;A&#46; Frantz"
                            3 => "M&#46; Siebert"
                            4 => "U&#46; Matte"
                            5 => "L&#46; Schuler-Faccini"
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                    ]
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                  "host" => array:1 [
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                      "Revista" => array:6 [
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                        "volumen" => "96"
                        "paginaInicial" => "155"
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                            3 => "R&#46;F&#46; Lellis"
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                    0 => array:1 [
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                        "tituloSerie" => "An Bras Dermatol&#46;"
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                        "paginaFinal" => "128"
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                  "contribucion" => array:1 [
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                      "titulo" => "Immunological mapping in hereditary epidermolysis bullosa"
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                          "etal" => false
                          "autores" => array:4 [
                            0 => "Z&#46;N&#46;P&#46; Oliveira"
                            1 => "A&#46;M&#46; P&#233;rigo"
                            2 => "L&#46;M&#46; Fukumori"
                            3 => "V&#46; Aoki"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/s0365-05962010000600012"
                      "Revista" => array:6 [
                        "tituloSerie" => "An Bras Dermatol&#46;"
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                        "volumen" => "85"
                        "paginaInicial" => "856"
                        "paginaFinal" => "861"
                        "link" => array:1 [
                          0 => array:2 [
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Genotype&#8208;phenotype correlations on epidermolysis bullosa with congenital absence of skin&#58; a comprehensive review"
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                            3 => "M&#46;J&#46;R&#46; Doriqui"
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                      "Revista" => array:6 [
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                        "paginaInicial" => "29"
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Article information
ISSN: 26662752
Original language: Portuguese
DOI:10.1016/j.abdp.2024.02.015
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