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conhecido por estar associado a alelos HLA e fatores ambientais&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">2&#8211;4</span></a> &#201; interessante notar que sua apresenta&#231;&#227;o cl&#237;nica tem sido associada a milia nas cicatrizes de les&#245;es bolhosas ou na pele n&#227;o lesionada em certos pacientes com PB&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">5</span></a> A presen&#231;a de milia est&#225; associada principalmente &#224; epiderm&#243;lise bolhosa adquirida &#40;EBA&#41; e porfiria cut&#226;nea tardia&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">6&#44;7</span></a> Prost et al&#46; &#40;1987&#41; descreveram a presen&#231;a de milia em casos de EBA e penfigoide cicatricial&#44; mas les&#245;es de milia estavam ausentes nos pacientes analisados com PB&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">8</span></a> Relatos sobre a associa&#231;&#227;o PB&#8208;milia v&#234;m aumentando nas &#250;ltimas d&#233;cadas em popula&#231;&#245;es diversas&#44; mas sua preval&#234;ncia e dados cl&#237;nico&#8208;laboratoriais ainda n&#227;o foram relatados na popula&#231;&#227;o brasileira com PB&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">9&#8211;15</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Dos 102 casos de PB compilados&#44; relatamos oito pacientes que apresentaram associa&#231;&#227;o com milia&#46; Avaliamos os achados cl&#237;nicos&#44; laboratoriais e de <span class="elsevierStyleItalic">immunoblotting</span> e determinamos os alelos HLA&#8208;DQ nesses oito pacientes com PB&#8208;milia&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Este estudo descritivo foi aprovado pelo Comit&#234; de &#201;tica local &#40;n&#176; 12248&#47;2010&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Foram revisados os prontu&#225;rios de 102 pacientes diagnosticados com PB em um per&#237;odo de 35 anos&#46; Todos eles moravam na regi&#227;o sudeste do Brasil&#46; O diagn&#243;stico de PB foi baseado em achados cl&#237;nicos&#44; confirmados pela presen&#231;a de bolhas subepid&#233;rmicas ao exame histopatol&#243;gico e por fluoresc&#234;ncia linear de IgG na zona da membrana basal &#40;ZMB&#41; por imunofluoresc&#234;ncia direta e indireta &#40;IFD e IFI&#44; respectivamente&#41;&#46; A IFI com anti&#8208;IgA e anti&#8208;IgG foi realizada pelo m&#233;todo <span class="elsevierStyleItalic">salt&#8208;split skin</span> &#40;SSS&#41;&#46; Os autoanticorpos IgG anti&#8208;BP180 e anti&#8208;BP230 foram determinados por ensaios ELISA &#40;valor de corte<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9 U&#47;mL&#59; MBL&#44; Jap&#227;o&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Os dados cl&#237;nicos foram avaliados para os oito pacientes com PB&#8208;milia inclu&#237;dos neste estudo&#44; e ensaios laboratoriais foram realizadas em amostras de DNA e soro armazenados&#46; Para a determina&#231;&#227;o de IgE total&#44; 50<span class="elsevierStyleHsp" style=""></span>&#956;L de soro foram preparados de acordo com as recomenda&#231;&#245;es do fabricante &#40;ImmunoCAPTM Total IgE&#44; Thermo&#8208;Fisher&#44; EUA&#41;&#46; A titula&#231;&#227;o foi realizada em Phadia100 &#40;Thermo&#8208;Fisher&#44; EUA&#41;&#46; Foram realizados os testes de <span class="elsevierStyleItalic">immunoblotting</span> &#40;IB&#41; com ant&#237;genos ZMB&#58; e com os dom&#237;nios C&#8208;terminais BP180&#8208;NC16a e BP180&#44; mol&#233;culas de BP230&#44; LAD&#8208;1&#44; col&#225;geno tipo VII e laminina&#8208;332&#46; Os alelos HLA&#8208;DQ foram determinados por PCR combinada com sondas oligonucleot&#237;dicas sequ&#234;ncia&#8208;espec&#237;ficas &#40;PCR&#8208;SSOP&#41;&#46; O kit LAB Type &#40;One Lambda Inc&#46;&#44; Kittredge&#44; CA&#44; EUA&#41; foi utilizado de acordo com as instru&#231;&#245;es do fabricante e a tecnologia Luminex&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0035" class="elsevierStylePara elsevierViewall">Dos 102 casos de PB compilados&#44; oito apresentaram les&#245;es de milia &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">figs&#46; 1 e 2</a>&#41;&#44; correspondendo &#224; preval&#234;ncia de PB&#8208;milia de 7&#44;8&#37;&#46; A <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> resume os dados demogr&#225;ficos e cl&#237;nicos desses oito pacientes&#46; Cinco eram do sexo masculino&#59; a mediana da idade era de 75&#44;5 anos&#59; e a mediana da dura&#231;&#227;o da doen&#231;a era de cinco meses&#46; A descri&#231;&#227;o cl&#237;nica mostrou les&#245;es ativas de PB nos oito pacientes&#46; Apenas um paciente apresentou acometimento mucoso&#46; Nenhum deles havia mudado sua medica&#231;&#227;o habitual antes do in&#237;cio do PB&#46; Digno de nota&#44; quatro pacientes apresentavam doen&#231;as neurol&#243;gicas &#40;DN&#41;&#46; Sete pacientes responderam bem ao tratamento usual&#44; e um faleceu em decorr&#234;ncia de tromboembolismo pulmonar ap&#243;s cirurgia de h&#233;rnia de disco&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a> detalha os achados laboratoriais&#46; Seis dos sete pacientes apresentavam bolha subepid&#233;rmica&#44; e infiltrado inflamat&#243;rio eosinof&#237;lico na derme superior predominou em quatro pacientes ao exame histopatol&#243;gico&#46; Em cinco desses pacientes&#44; a IFD confirmou IgG ou C3&#44; ou ambos&#44; mas nenhuma fluoresc&#234;ncia linear de IgA na ZMB &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>A&#41;&#46; Em oito pacientes&#44; SSS&#8208;IFI demonstrou IgG ou C3&#44; ou ambos&#44; mas nenhuma fluoresc&#234;ncia linear de IgA no lado epid&#233;rmico da clivagem &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>B&#41;&#46; De interesse&#44; o aumento dos n&#237;veis s&#233;ricos de IgE total variando de 252 a &#62;<span class="elsevierStyleHsp" style=""></span>5&#46;000 kU&#47;mL foi documentado em sete dos oito pacientes&#46; Entre os oito pacientes&#44; o teste ELISA mostrou n&#237;veis aumentados de anticorpos anti&#8208;BP180&#44; anti&#8208;BP230 e em ambos anti&#8208;BP180 e anti&#8208;BP230 em dois&#44; um e tr&#234;s pacientes&#44; respectivamente&#59; dois pacientes testaram negativo para os anticorpos anti&#8208;BP180 e anti&#8208;BP230&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Entre os oito pacientes&#44; os testes de IB destacaram a reatividade de IgG contra BP230 em um paciente &#40;dados n&#227;o mostrados&#41;&#44; contra o dom&#237;nio BP180&#8208;NC16a em cinco pacientes &#40;<a class="elsevierStyleCrossRef" href="#fig0020">fig&#46; 4</a>A&#41; e contra o dom&#237;nio C&#8208;terminal de BP180 ou LAD&#8208;1&#44; ou ambos&#44; em quatro pacientes &#40;<a class="elsevierStyleCrossRef" href="#fig0020">figs&#46; 4</a>B e C&#41;&#46; Nenhum paciente apresentou reatividade contra col&#225;geno tipo VII ou laminina&#8208;332&#46; Os alelos HLA&#8208;DQ foram definidos em cinco dos oito pacientes &#40;ver <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#44; &#250;ltima coluna&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0050" class="elsevierStylePara elsevierViewall">Que seja de nosso conhecimento&#44; a associa&#231;&#227;o PB&#8208;milia ainda &#233; considerada um achado cl&#237;nico incomum&#46;<span class="elsevierStyleSup">5&#44;9&#8211;15</span> N&#227;o h&#225; relato da associa&#231;&#227;o PB&#8208;milia na popula&#231;&#227;o brasileira&#46; Aqui&#44; &#233; apresentada a preval&#234;ncia de 7&#44;8&#37; de associa&#231;&#227;o PB&#8208;milia em 102 pacientes com PB&#44; indicando que o diagn&#243;stico diferencial cuidadoso com EBA &#233; obrigat&#243;rio&#44; visto que a forma&#231;&#227;o de milia &#233; frequentemente relatada em EBA&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">6</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Em virtude do aumento do dos relatos da associa&#231;&#227;o PB&#8208;milia&#44; &#233; interessante destacar algumas caracter&#237;sticas cl&#237;nicas e laboratoriais apresentadas pelos oito pacientes PB&#8208;milia&#58; &#40;i&#41; Associa&#231;&#227;o com DN foi descrita em quatro pacientes &#8208; tr&#234;s com acidente vascular cerebral &#40;pacientes 3&#44; 5 e 6&#41; e um com doen&#231;a de Parkinson e dem&#234;ncia &#40;paciente 8&#41;&#46; DN em associa&#231;&#227;o com PB estabelece uma rela&#231;&#227;o interessante para a patog&#234;nese do PB&#44;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">4&#44;16</span></a> mas nenhuma associa&#231;&#227;o DN&#8208;PB&#8208;milia foi encontrada na literatura&#46; &#40;ii&#41; N&#237;veis de IgE total aumentados foram demonstrados em sete pacientes&#46; O aumento da IgE total foi relacionado &#224; gravidade do PB&#44;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">17&#8211;20</span></a> e foi relatado em um caso de associa&#231;&#227;o de PB&#8208;milia&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">13</span></a> O fato do aumento da IgE total ter sido identificado em 87&#44;5&#37; dos pacientes com PB&#8208;milia aqui inclu&#237;dos merece confirma&#231;&#227;o futura&#46; &#40;iii&#41; Curiosamente&#44; quatro pacientes apresentaram anticorpos contra o dom&#237;nio C&#8208;terminal de BP180 e LAD&#8208;1 em IB&#46; A intera&#231;&#227;o de prote&#237;nas hemidesmoss&#244;micas e componentes da matriz extracelular sob os hemidesmossomos tamb&#233;m pode resultar na forma&#231;&#227;o de milia&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">5</span></a> mas essas caracter&#237;sticas n&#227;o s&#227;o exclusivas da associa&#231;&#227;o PB&#8208;milia&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Por fim&#44; os genes HLA s&#227;o provavelmente o fator de predisposi&#231;&#227;o gen&#233;tica mais significativo na patog&#234;nese da PB&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">2</span></a> Na maior s&#233;rie de casos de associa&#231;&#227;o PB&#8208;milia at&#233; o momento&#44; les&#245;es de milia estavam presentes em 23 &#40;31&#44;1&#37;&#41; dos 74 pacientes brit&#226;nicos com PB&#44; e o grupo al&#233;lico <span class="elsevierStyleItalic">HLA&#8208;DQ6</span> foi associado &#224; condi&#231;&#227;o PB&#8208;milia&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">21</span></a> Aqui&#44; tr&#234;s dos cinco casos apresentavam o grupo al&#233;lico <span class="elsevierStyleItalic">HLA&#8208;DQB1&#42;06</span>&#46; Al&#233;m disso&#44; tr&#234;s exibiam os alelos <span class="elsevierStyleItalic">HLA</span>&#8208;<span class="elsevierStyleItalic">DQA1</span>&#42;01&#58;03&#47;05&#58;05&#44; o alelo <span class="elsevierStyleItalic">HLA&#8208;DQB1&#42;03&#58;01</span>&#44; ou todos eles&#44; que representam alelos de suscetibilidade ao PB na popula&#231;&#227;o brasileira&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">22</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#227;o</span><p id="par0065" class="elsevierStylePara elsevierViewall">Em conclus&#227;o&#44; les&#245;es de milia parecem ser uma descri&#231;&#227;o cl&#237;nica atual associada ao PB&#44; configurando um diagn&#243;stico diferencial especial com outras doen&#231;as bolhosas&#46; A forma&#231;&#227;o de milia em PB merece uma explica&#231;&#227;o baseada na patog&#234;nese do motivo pelo qual certos pacientes com PB as desenvolvem&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Suporte financeiro</span><p id="par0070" class="elsevierStylePara elsevierViewall">Este estudo foi parcialmente financiado pela FAPESP &#40;Funda&#231;&#227;o de Amparo &#224; Pesquisa do Estado de S&#227;o Paulo&#41;&#44; processo n&#250;mero 2010&#47;51729&#8208;2&#44; e pela FAEPA &#40;Funda&#231;&#227;o de Apoio ao Ensino&#44; Pesquisa e Assist&#234;ncia&#41;&#46; SV e TAJ receberam bolsa de doutorado da CAPES &#40;Coordena&#231;&#227;o de Aperfei&#231;oamento de Pessoal de N&#237;vel Superior&#41; e da FAPESP&#44; respectivamente&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Contribui&#231;&#227;o dos autores</span><p id="par0075" class="elsevierStylePara elsevierViewall">Sebasti&#225;n Vernal&#58; Contribuiu com a obten&#231;&#227;o e interpreta&#231;&#227;o dos dados&#44; reda&#231;&#227;o do manuscrito&#44; participa&#231;&#227;o efetiva&#44; revis&#227;o da literatura&#44; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Ederson Valei de Oliveira&#58; Contribuiu com a obten&#231;&#227;o e interpreta&#231;&#227;o dos dados&#44; participa&#231;&#227;o efetiva&#44; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Roberto Bueno Filho&#58; Contribuiu com a obten&#231;&#227;o e interpreta&#231;&#227;o dos dados&#44; participa&#231;&#227;o efetiva&#44; participa&#231;&#227;o em conduta terap&#234;utica dos casos estudados&#44; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Tamiris A&#46; Julio&#58; Contribuiu com a obten&#231;&#227;o e interpreta&#231;&#227;o dos dados&#44; participa&#231;&#227;o efetiva&#44; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Eduardo A&#46; Donadi&#58; Contribuiu com a obten&#231;&#227;o e interpreta&#231;&#227;o dos dados&#44; participa&#231;&#227;o efetiva&#44; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Aline Turatti&#58; Contribuiu com a obten&#231;&#227;o e interpreta&#231;&#227;o dos dados&#44; participa&#231;&#227;o efetiva&#44; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Norito Ishii&#58; Contribuiu com a obten&#231;&#227;o e interpreta&#231;&#227;o dos dados&#44; participa&#231;&#227;o efetiva&#44; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Takashi Hashimoto&#58; Contribuiu com a obten&#231;&#227;o e interpreta&#231;&#227;o dos dados&#44; participa&#231;&#227;o efetiva&#44; reda&#231;&#227;o do manuscrito&#44; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Ana Maria Roselino&#58; Contribuiu com a concep&#231;&#227;o e planejamento do estudo&#44; obten&#231;&#227;o e interpreta&#231;&#227;o dos dados&#44; reda&#231;&#227;o do manuscrito&#44; participa&#231;&#227;o efetiva&#44; revis&#227;o da literatura&#44; participa&#231;&#227;o em conduta terap&#234;utica dos casos estudados&#44; 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="par0120" 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">A associa&#231;&#227;o entre penfigoide bolhoso &#40;PB&#41; e les&#245;es de milia tem sido cada vez mais relatada&#44; mas sua preval&#234;ncia ainda n&#227;o havia sido relatada em uma popula&#231;&#227;o brasileira com PB&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Descrever a ocorr&#234;ncia e os achados cl&#237;nico&#8208;laboratoriais da associa&#231;&#227;o PB&#8208;milia em uma amostra da regi&#227;o sudeste brasileira&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Realizou-se estudo descritivo baseado nos prontu&#225;rios de 102 pacientes com PB&#46; Dados cl&#237;nicos e laboratoriais de pacientes com PB&#8208;milia foram obtidos&#46; IgE s&#233;rica total&#44; ensaios de <span class="elsevierStyleItalic">immunoblotting</span> com base em ant&#237;genos da zona da membrana basal e tipagem de alelos HLA&#8208;DQ foram realizados&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Les&#245;es de milia foram evidentes em oito &#40;7&#44;8&#37;&#41; pacientes com PB&#44; cinco do sexo masculino&#44; com idade entre 46 e 88 anos&#46; N&#237;veis elevados de IgE total foram determinados em sete &#40;87&#44;5&#37;&#41; de oito pacientes&#46; Em cinco dos oito pacientes&#44; o <span class="elsevierStyleItalic">immunoblotting</span> mostrou reatividade de IgG contra o dom&#237;nio BP180&#8208;NC16a&#44; mas n&#227;o contra col&#225;geno VII ou laminina&#8208;332&#59; tamb&#233;m revelou reatividade contra o dom&#237;nio C&#8208;terminal de BP180 ou LAD&#8208;1&#44; ou ambos em quatro deles&#46; Os alelos <span class="elsevierStyleItalic">HLA&#8208;DQB1</span>&#42;03&#58;01 e <span class="elsevierStyleItalic">HLA&#8208;DQA1</span>&#42;05&#58;05 foram identificados em tr&#234;s desses cinco pacientes com PB&#8208;milia&#46; Al&#233;m disso&#44; tr&#234;s dos cinco casos apresentaram o grupo al&#233;lico <span class="elsevierStyleItalic">HLA-DQB1&#42;</span>06&#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">O HLA foi determinado em cinco pacientes&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#245;es</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A forma&#231;&#227;o de milia em pacientes com PB parece ser menos incomum do que anteriormente admitido&#46; Os dados laboratoriais revelaram aumento de IgE&#59; autoanticorpos contra o dom&#237;nio C&#8208;terminal de BP180 ou LAD&#8208;1&#44; ou ambos&#59; e o grupo al&#233;lico <span class="elsevierStyleItalic">HLA-DQB1&#42;</span>06&#44; descrito na associa&#231;&#227;o PB&#8208;milia&#46; A determina&#231;&#227;o cuidadosa de anticorpos contra mol&#233;culas da zona da membrana basal e a caracteriza&#231;&#227;o do HLA em diferentes popula&#231;&#245;es podem fornecer mais informa&#231;&#245;es sobre essa associa&#231;&#227;o&#46;</p></span>"
        "secciones" => array:6 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Fundamentos"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objetivos"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "M&#233;todos"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Resultados"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Limita&#231;&#245;es do estudo"
          ]
          5 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Conclus&#245;es"
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        ]
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    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Como citar este artigo&#58; Vernal S&#44; Oliveira EV&#44; Bueno Filho R&#44; Julio TA&#44; Donadi EA&#44; Turatti A&#44; et al&#46; Bullous pemphigoid and milia&#58; prevalence and clinical laboratory findings in a Brazilian sample&#46; An Bras Dermatol&#46; 2022&#59;97&#58;435&#8211;42&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Trabalho realizado no Hospital Universit&#225;rio&#44; Faculdade de Medicina de Ribeir&#227;o Preto&#44; Universidade de S&#227;o Paulo&#44;&#160;Ribeir&#227;o Preto&#44;&#160;SP&#44; Brasil e na Kurume University Institute of Cutaneous Cell Biology&#44; &#223;ukuoka&#44; Jap&#227;o&#46;</p>"
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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            "Alto" => 866
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Paciente n&#250;mero 2 nas tabelas 1 e 2&#46; &#40;A&#41;&#44; Les&#245;es crostosas sobre placas eritematosas no t&#243;rax anterior e abd&#244;men&#46; &#40;B&#41;&#44; Les&#245;es de milia &#40;<span class="elsevierStyleItalic">setas brancas</span>&#41; sobre les&#245;es cicatriciais podem ser vistas nessa imagem com amplia&#231;&#227;o&#46;</p>"
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      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figura 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 715
            "Ancho" => 2005
            "Tamanyo" => 125387
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        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Paciente n&#250;mero 4 nas tabelas 1 e 2&#46; &#40;A&#41;&#44; Bolha hemorr&#225;gica e tensa sobre placas eritematosas no p&#233;&#46; &#40;B&#41;&#44; Les&#245;es de milia &#40;<span class="elsevierStyleItalic">seta branca</span>&#41; sobre les&#245;es cicatriciais podem ser vistas&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figura 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 689
            "Ancho" => 2000
            "Tamanyo" => 148977
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41;&#44; Imunofluoresc&#234;ncia direta em bi&#243;psia de pele mostrando fluoresc&#234;ncia linear de IgG na zona da membrana basal &#40;<span class="elsevierStyleItalic">seta branca</span>&#59; paciente 2&#41;&#46; Imunofluoresc&#234;ncia&#44; 400<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>&#46; &#40;B&#41;&#44; Imunofluoresc&#234;ncia indireta utilizando 1M&#8208;NaCl&#8208;salt&#8208;split skin mostra fluoresc&#234;ncia de IgG no lado epid&#233;rmico de clivagem &#40;paciente&#160;5&#41;&#46; Imunofluoresc&#234;ncia&#44; 400<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>&#46;</p>"
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      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figura 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Immunoblotting</span> utilizando BP180&#8208;NC16a &#40;A&#41; C&#8208;terminal BP180 &#40;B&#41; e c&#233;lulas HaCaT &#40;C&#41; com amostras de soro&#46; Para resultados positivos&#44; procure a prote&#237;na de refer&#234;ncia &#40;PR&#41; de&#58; soro do paciente PB &#40;penfigoide bolhoso&#41; &#40;A&#41;&#44; MMP&#44; soro do paciente com penfigoide das membranas mucosas &#40;B&#41; e LAD&#58; soro do paciente com dermatose IgA linear &#40;C&#41;&#46;</p>"
        ]
      ]
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        "etiqueta" => "Tabela 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabela "
            "rol" => "short"
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        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&#250;mero do paciente&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">Sexo&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">Idade &#40;anos&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dura&#231;&#227;o da doen&#231;a &#40;meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Distribui&#231;&#227;o das les&#245;es&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">Hist&#243;rico m&#233;dico e comorbidades&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">Medicamentos em uso no in&#237;cio das les&#245;es de PB&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">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">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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">Tronco&#44; membros&#44; m&#227;os e p&#233;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Erisipela recorrente&#44; hipertens&#227;o&#44; dislipidemia e c&#226;ncer de bexiga ressecado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enalapril&#44; amlodipina&#44; sinvastatina&#44; carvedilol e omeprazol&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">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">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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">Tronco&#44; abdome e membros&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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 da tireoide&#44; hipertens&#227;o&#44; diabetes <span class="elsevierStyleItalic">mellitus</span> tipo 2 e hist&#243;ria de histoplasmose pulmonar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Metformina&#44; losartana&#44; aspirina&#44; ramipril&#44; omeprazol e atorvastatina&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">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">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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">Tronco e membros inferiores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipertens&#227;o&#44; diabetes <span class="elsevierStyleItalic">mellitus</span> tipo 2 e acidente vascular encef&#225;lico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aspirina&#44; carvedilol&#44; furosemida&#44; dinitrato de isossorbida&#44; omeprazol&#44; NPH e insulina&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">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">Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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">Pesco&#231;o&#44; tronco e membros&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipertens&#227;o&#44; hipotireoidismo&#44; hiperparatireoidismo e asma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Losartana&#44; amlodipina&#44; levotiroxina&#44; ranitidina&#44; duloxetina&#44; pregabalina&#44; primidona&#44; carbonato de c&#225;lcio&#44; pidolato de magn&#233;sio&#44; cloreto de pot&#225;ssio&#44; &#225;cido f&#243;lico e vitamina E&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">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">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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">Tronco e m&#227;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipertens&#227;o&#44; diabetes <span class="elsevierStyleItalic">mellitus</span> tipo 2&#44; dislipidemia e acidente vascular encef&#225;lico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hidroclorotiazida&#44; atenolol&#44; aspirina&#44; fenito&#237;na&#44; metformina&#44; sinvastatina&#44; diosmina&#44; indapamida e cilostazol&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">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">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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">Couro cabeludo&#44; face&#44; tronco&#44; abd&#244;men e membros superiores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipertens&#227;o&#44; dislipidemia&#44; tabagismo&#44; alcoolismo&#44; infec&#231;&#227;o urin&#225;ria de repeti&#231;&#227;o&#44; acidente vascular encef&#225;lico e epis&#243;dio de psicose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hidroclorotiazida&#44; sinvastatina&#44; clopidogrel&#44; nortriptilina e amiodarona&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">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">Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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">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">Regi&#227;o axilar&#44; coxas e p&#233;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cefaleia cr&#244;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Desogestrel&#44; etinilestradiol e metamizol&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">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">Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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">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">Mucosa oral&#44; t&#243;rax&#44; m&#227;os e p&#233;s e regi&#227;o inguinal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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 Parkinson e dem&#234;ncia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prolopa&#44; domperidona&#44; omeprazol&#44; doxiciclina e nicotinamida&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Dados demogr&#225;ficos e cl&#237;nicos de pacientes com associa&#231;&#227;o PB&#8208;milia</p>"
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        "etiqueta" => "Tabela 2"
        "tipo" => "MULTIMEDIATABLA"
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          0 => array:3 [
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">PB&#44; penfigoide bolhoso&#59; IFD&#44; imunofluoresc&#234;ncia direta com deposi&#231;&#227;o de fluoresc&#234;ncia linear ao longo da zona da membrana basal&#59; SSS&#8208;IFI&#44; m&#233;todo <span class="elsevierStyleItalic">salt&#8208;split skin</span> na imunofluoresc&#234;ncia indireta com fluoresc&#234;ncia linear na clivagem epid&#233;rmica&#59; fluoresc&#234;ncia IgA negativa&#46; N&#46;D&#46;&#44; n&#227;o dispon&#237;vel&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&#250;mero do paciente&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">Caracter&#237;sticas histopatol&#243;gicas na bi&#243;psia de pele&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">IFD&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">SSS&#8208; IFI&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">IgE s&#233;rico &#40;kU&#47;mL&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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">Anti&#8208;BP180 &#40;U&#47;mL&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&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">Anti&#8208;BP230 &#40;U&#47;mL&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&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">Achados de <span class="elsevierStyleItalic">Immunoblotting</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Alelos<span class="elsevierStyleItalic">HLA&#8208;DQ</span>&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">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">Bolha subepid&#233;rmica com eosin&#243;filos dentro da bolha e na derme superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IgG e C3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IgG e C3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62; 5000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">128&#44;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">137&#44;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">Dom&#237;nio BP180&#8208;NC16a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&#46;D&#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">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">Descolamento epid&#233;rmico&#59; infiltrado inflamat&#243;rio com linf&#243;citos&#44; neutr&#243;filos e eosin&#243;filos na derme superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C3 e fibrinog&#234;nio&#59; IgG negativo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IgG e C3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62; 5000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;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">4&#44;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">Dom&#237;nio C&#8208;terminal BP180 e LAD&#8208;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">N&#46;D&#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">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">Epiderme exibindo leve espongiose&#46; Discreto infiltrado inflamat&#243;rio linfocit&#225;rio intersticial na derme superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negativo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IgG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">782&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&#44;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;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">Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&#46;A&#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">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">Foco de descolamento epid&#233;rmico&#46; Infiltrado inflamat&#243;rio perivascular e intersticial leve com linf&#243;citos na derme superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IgG e C3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IgG e C3&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"><span class="elsevierStyleHsp" style=""></span>&#62; 5000&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">159&#44;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">72&#44;0&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">Dom&#237;nio BP180&#8208;NC16a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">DQA1&#42;</span> 01&#58;02&#47;02&#58;01&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\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
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">DQB1&#42;</span> 02&#58;02&#47;06&#58;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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">N&#46;D&#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">IgG e C3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IgG&nbsp;\t\t\t\t\t\t\n
                  \t\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">252&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">107&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;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">BP180&#8208;NC16a&#44; dom&#237;nio C&#8208;terminal BP180&#44; e LAD&#8208;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"><span class="elsevierStyleItalic">DQA1&#42;</span> 01&#58;01&#47;05&#58;05&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\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
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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><td class="td" title="\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><td class="td" title="\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><td class="td" title="\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><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">DQB1&#42;</span> 03&#58;01&#47;05&#58;01&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">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">Ves&#237;cula subepid&#233;rmica com fibrina&#44; neutr&#243;filos e linf&#243;citos&#46; Moderado infiltrado linfocit&#225;rio perianexial&#44; perivascular e intersticial na derme superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negativo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IgG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1286&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;4&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">68&#44;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">BP230&#59; dom&#237;nio C&#8208;terminal BP180&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">DQA1&#42;</span> 01&#58;02&#47;02&#58;01&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"><span class="elsevierStyleItalic">DQB1&#42;</span> 02&#58;02&#47;06&#58;02&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">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">Ves&#237;cula subepid&#233;rmica&#59; infiltrado inflamat&#243;rio com numerosos eosin&#243;filos e linf&#243;citos na derme superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&#46;D&#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">IgG&nbsp;\t\t\t\t\t\t\n
                  \t\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">7&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;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">BP180&#8208;NC16a&#44; dom&#237;nio C&#8208;terminal BP180&#44; e LAD&#8208;1&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"><span class="elsevierStyleItalic">DQA1&#42;</span> 05&#58;05&#47;05&#58;05&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">DQB1&#42;</span> 03&#58;01&#47;03&#58;01&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">8&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">Ves&#237;cula subepid&#233;rmica com alguns eosin&#243;filos em seu interior&#59; ceratin&#243;citos necr&#243;ticos no assoalho da clivagem&#46; Infiltrado inflamat&#243;rio intersticial e perivascular com predom&#237;nio de linf&#243;citos e eosin&#243;filos na derme superior&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">427&nbsp;\t\t\t\t\t\t\n
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          "pt" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Dados laboratoriais de pacientes com associa&#231;&#227;o PB&#8208;milia</p>"
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Artigo original
Penfigoide bolhoso e milia: prevalência e achados clínico‐laboratoriais em amostra brasileira
Sebastián Vernala, Ederson Valei de Oliveirab, Roberto Bueno Filhob, Tamiris A. Julioa, Eduardo A. Donadic, Aline Turattia, Norito Ishiid, Takashi Hashimotod, Ana Maria Roselinoa,b,
Autor para correspondência
amfrosel@fmrp.usp.br

Autor para correspondência.
a Laboratório de Dermatologia, Hospital Universitário, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
b Hospital Universitário, Divisão de Dermatologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
c Divisão de Imunologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
d Departamento de Dermatologia, Kurume University School of Medicine e Kurume University Institute of Cutaneous Cell Biology, Fukuoka, Japão
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6316
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2022
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conhecido por estar associado a alelos HLA e fatores ambientais&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">2&#8211;4</span></a> &#201; interessante notar que sua apresenta&#231;&#227;o cl&#237;nica tem sido associada a milia nas cicatrizes de les&#245;es bolhosas ou na pele n&#227;o lesionada em certos pacientes com PB&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">5</span></a> A presen&#231;a de milia est&#225; associada principalmente &#224; epiderm&#243;lise bolhosa adquirida &#40;EBA&#41; e porfiria cut&#226;nea tardia&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">6&#44;7</span></a> Prost et al&#46; &#40;1987&#41; descreveram a presen&#231;a de milia em casos de EBA e penfigoide cicatricial&#44; mas les&#245;es de milia estavam ausentes nos pacientes analisados com PB&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">8</span></a> Relatos sobre a associa&#231;&#227;o PB&#8208;milia v&#234;m aumentando nas &#250;ltimas d&#233;cadas em popula&#231;&#245;es diversas&#44; mas sua preval&#234;ncia e dados cl&#237;nico&#8208;laboratoriais ainda n&#227;o foram relatados na popula&#231;&#227;o brasileira com PB&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">9&#8211;15</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Dos 102 casos de PB compilados&#44; relatamos oito pacientes que apresentaram associa&#231;&#227;o com milia&#46; Avaliamos os achados cl&#237;nicos&#44; laboratoriais e de <span class="elsevierStyleItalic">immunoblotting</span> e determinamos os alelos HLA&#8208;DQ nesses oito pacientes com PB&#8208;milia&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Este estudo descritivo foi aprovado pelo Comit&#234; de &#201;tica local &#40;n&#176; 12248&#47;2010&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Foram revisados os prontu&#225;rios de 102 pacientes diagnosticados com PB em um per&#237;odo de 35 anos&#46; Todos eles moravam na regi&#227;o sudeste do Brasil&#46; O diagn&#243;stico de PB foi baseado em achados cl&#237;nicos&#44; confirmados pela presen&#231;a de bolhas subepid&#233;rmicas ao exame histopatol&#243;gico e por fluoresc&#234;ncia linear de IgG na zona da membrana basal &#40;ZMB&#41; por imunofluoresc&#234;ncia direta e indireta &#40;IFD e IFI&#44; respectivamente&#41;&#46; A IFI com anti&#8208;IgA e anti&#8208;IgG foi realizada pelo m&#233;todo <span class="elsevierStyleItalic">salt&#8208;split skin</span> &#40;SSS&#41;&#46; Os autoanticorpos IgG anti&#8208;BP180 e anti&#8208;BP230 foram determinados por ensaios ELISA &#40;valor de corte<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9 U&#47;mL&#59; MBL&#44; Jap&#227;o&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Os dados cl&#237;nicos foram avaliados para os oito pacientes com PB&#8208;milia inclu&#237;dos neste estudo&#44; e ensaios laboratoriais foram realizadas em amostras de DNA e soro armazenados&#46; Para a determina&#231;&#227;o de IgE total&#44; 50<span class="elsevierStyleHsp" style=""></span>&#956;L de soro foram preparados de acordo com as recomenda&#231;&#245;es do fabricante &#40;ImmunoCAPTM Total IgE&#44; Thermo&#8208;Fisher&#44; EUA&#41;&#46; A titula&#231;&#227;o foi realizada em Phadia100 &#40;Thermo&#8208;Fisher&#44; EUA&#41;&#46; Foram realizados os testes de <span class="elsevierStyleItalic">immunoblotting</span> &#40;IB&#41; com ant&#237;genos ZMB&#58; e com os dom&#237;nios C&#8208;terminais BP180&#8208;NC16a e BP180&#44; mol&#233;culas de BP230&#44; LAD&#8208;1&#44; col&#225;geno tipo VII e laminina&#8208;332&#46; Os alelos HLA&#8208;DQ foram determinados por PCR combinada com sondas oligonucleot&#237;dicas sequ&#234;ncia&#8208;espec&#237;ficas &#40;PCR&#8208;SSOP&#41;&#46; O kit LAB Type &#40;One Lambda Inc&#46;&#44; Kittredge&#44; CA&#44; EUA&#41; foi utilizado de acordo com as instru&#231;&#245;es do fabricante e a tecnologia Luminex&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0035" class="elsevierStylePara elsevierViewall">Dos 102 casos de PB compilados&#44; oito apresentaram les&#245;es de milia &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">figs&#46; 1 e 2</a>&#41;&#44; correspondendo &#224; preval&#234;ncia de PB&#8208;milia de 7&#44;8&#37;&#46; A <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> resume os dados demogr&#225;ficos e cl&#237;nicos desses oito pacientes&#46; Cinco eram do sexo masculino&#59; a mediana da idade era de 75&#44;5 anos&#59; e a mediana da dura&#231;&#227;o da doen&#231;a era de cinco meses&#46; A descri&#231;&#227;o cl&#237;nica mostrou les&#245;es ativas de PB nos oito pacientes&#46; Apenas um paciente apresentou acometimento mucoso&#46; Nenhum deles havia mudado sua medica&#231;&#227;o habitual antes do in&#237;cio do PB&#46; Digno de nota&#44; quatro pacientes apresentavam doen&#231;as neurol&#243;gicas &#40;DN&#41;&#46; Sete pacientes responderam bem ao tratamento usual&#44; e um faleceu em decorr&#234;ncia de tromboembolismo pulmonar ap&#243;s cirurgia de h&#233;rnia de disco&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a> detalha os achados laboratoriais&#46; Seis dos sete pacientes apresentavam bolha subepid&#233;rmica&#44; e infiltrado inflamat&#243;rio eosinof&#237;lico na derme superior predominou em quatro pacientes ao exame histopatol&#243;gico&#46; Em cinco desses pacientes&#44; a IFD confirmou IgG ou C3&#44; ou ambos&#44; mas nenhuma fluoresc&#234;ncia linear de IgA na ZMB &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>A&#41;&#46; Em oito pacientes&#44; SSS&#8208;IFI demonstrou IgG ou C3&#44; ou ambos&#44; mas nenhuma fluoresc&#234;ncia linear de IgA no lado epid&#233;rmico da clivagem &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>B&#41;&#46; De interesse&#44; o aumento dos n&#237;veis s&#233;ricos de IgE total variando de 252 a &#62;<span class="elsevierStyleHsp" style=""></span>5&#46;000 kU&#47;mL foi documentado em sete dos oito pacientes&#46; Entre os oito pacientes&#44; o teste ELISA mostrou n&#237;veis aumentados de anticorpos anti&#8208;BP180&#44; anti&#8208;BP230 e em ambos anti&#8208;BP180 e anti&#8208;BP230 em dois&#44; um e tr&#234;s pacientes&#44; respectivamente&#59; dois pacientes testaram negativo para os anticorpos anti&#8208;BP180 e anti&#8208;BP230&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Entre os oito pacientes&#44; os testes de IB destacaram a reatividade de IgG contra BP230 em um paciente &#40;dados n&#227;o mostrados&#41;&#44; contra o dom&#237;nio BP180&#8208;NC16a em cinco pacientes &#40;<a class="elsevierStyleCrossRef" href="#fig0020">fig&#46; 4</a>A&#41; e contra o dom&#237;nio C&#8208;terminal de BP180 ou LAD&#8208;1&#44; ou ambos&#44; em quatro pacientes &#40;<a class="elsevierStyleCrossRef" href="#fig0020">figs&#46; 4</a>B e C&#41;&#46; Nenhum paciente apresentou reatividade contra col&#225;geno tipo VII ou laminina&#8208;332&#46; Os alelos HLA&#8208;DQ foram definidos em cinco dos oito pacientes &#40;ver <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#44; &#250;ltima coluna&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0050" class="elsevierStylePara elsevierViewall">Que seja de nosso conhecimento&#44; a associa&#231;&#227;o PB&#8208;milia ainda &#233; considerada um achado cl&#237;nico incomum&#46;<span class="elsevierStyleSup">5&#44;9&#8211;15</span> N&#227;o h&#225; relato da associa&#231;&#227;o PB&#8208;milia na popula&#231;&#227;o brasileira&#46; Aqui&#44; &#233; apresentada a preval&#234;ncia de 7&#44;8&#37; de associa&#231;&#227;o PB&#8208;milia em 102 pacientes com PB&#44; indicando que o diagn&#243;stico diferencial cuidadoso com EBA &#233; obrigat&#243;rio&#44; visto que a forma&#231;&#227;o de milia &#233; frequentemente relatada em EBA&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">6</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Em virtude do aumento do dos relatos da associa&#231;&#227;o PB&#8208;milia&#44; &#233; interessante destacar algumas caracter&#237;sticas cl&#237;nicas e laboratoriais apresentadas pelos oito pacientes PB&#8208;milia&#58; &#40;i&#41; Associa&#231;&#227;o com DN foi descrita em quatro pacientes &#8208; tr&#234;s com acidente vascular cerebral &#40;pacientes 3&#44; 5 e 6&#41; e um com doen&#231;a de Parkinson e dem&#234;ncia &#40;paciente 8&#41;&#46; DN em associa&#231;&#227;o com PB estabelece uma rela&#231;&#227;o interessante para a patog&#234;nese do PB&#44;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">4&#44;16</span></a> mas nenhuma associa&#231;&#227;o DN&#8208;PB&#8208;milia foi encontrada na literatura&#46; &#40;ii&#41; N&#237;veis de IgE total aumentados foram demonstrados em sete pacientes&#46; O aumento da IgE total foi relacionado &#224; gravidade do PB&#44;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">17&#8211;20</span></a> e foi relatado em um caso de associa&#231;&#227;o de PB&#8208;milia&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">13</span></a> O fato do aumento da IgE total ter sido identificado em 87&#44;5&#37; dos pacientes com PB&#8208;milia aqui inclu&#237;dos merece confirma&#231;&#227;o futura&#46; &#40;iii&#41; Curiosamente&#44; quatro pacientes apresentaram anticorpos contra o dom&#237;nio C&#8208;terminal de BP180 e LAD&#8208;1 em IB&#46; A intera&#231;&#227;o de prote&#237;nas hemidesmoss&#244;micas e componentes da matriz extracelular sob os hemidesmossomos tamb&#233;m pode resultar na forma&#231;&#227;o de milia&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">5</span></a> mas essas caracter&#237;sticas n&#227;o s&#227;o exclusivas da associa&#231;&#227;o PB&#8208;milia&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Por fim&#44; os genes HLA s&#227;o provavelmente o fator de predisposi&#231;&#227;o gen&#233;tica mais significativo na patog&#234;nese da PB&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">2</span></a> Na maior s&#233;rie de casos de associa&#231;&#227;o PB&#8208;milia at&#233; o momento&#44; les&#245;es de milia estavam presentes em 23 &#40;31&#44;1&#37;&#41; dos 74 pacientes brit&#226;nicos com PB&#44; e o grupo al&#233;lico <span class="elsevierStyleItalic">HLA&#8208;DQ6</span> foi associado &#224; condi&#231;&#227;o PB&#8208;milia&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">21</span></a> Aqui&#44; tr&#234;s dos cinco casos apresentavam o grupo al&#233;lico <span class="elsevierStyleItalic">HLA&#8208;DQB1&#42;06</span>&#46; Al&#233;m disso&#44; tr&#234;s exibiam os alelos <span class="elsevierStyleItalic">HLA</span>&#8208;<span class="elsevierStyleItalic">DQA1</span>&#42;01&#58;03&#47;05&#58;05&#44; o alelo <span class="elsevierStyleItalic">HLA&#8208;DQB1&#42;03&#58;01</span>&#44; ou todos eles&#44; que representam alelos de suscetibilidade ao PB na popula&#231;&#227;o brasileira&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">22</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#227;o</span><p id="par0065" class="elsevierStylePara elsevierViewall">Em conclus&#227;o&#44; les&#245;es de milia parecem ser uma descri&#231;&#227;o cl&#237;nica atual associada ao PB&#44; configurando um diagn&#243;stico diferencial especial com outras doen&#231;as bolhosas&#46; A forma&#231;&#227;o de milia em PB merece uma explica&#231;&#227;o baseada na patog&#234;nese do motivo pelo qual certos pacientes com PB as desenvolvem&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Suporte financeiro</span><p id="par0070" class="elsevierStylePara elsevierViewall">Este estudo foi parcialmente financiado pela FAPESP &#40;Funda&#231;&#227;o de Amparo &#224; Pesquisa do Estado de S&#227;o Paulo&#41;&#44; processo n&#250;mero 2010&#47;51729&#8208;2&#44; e pela FAEPA &#40;Funda&#231;&#227;o de Apoio ao Ensino&#44; Pesquisa e Assist&#234;ncia&#41;&#46; SV e TAJ receberam bolsa de doutorado da CAPES &#40;Coordena&#231;&#227;o de Aperfei&#231;oamento de Pessoal de N&#237;vel Superior&#41; e da FAPESP&#44; respectivamente&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Contribui&#231;&#227;o dos autores</span><p id="par0075" class="elsevierStylePara elsevierViewall">Sebasti&#225;n Vernal&#58; Contribuiu com a obten&#231;&#227;o e interpreta&#231;&#227;o dos dados&#44; reda&#231;&#227;o do manuscrito&#44; participa&#231;&#227;o efetiva&#44; revis&#227;o da literatura&#44; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Ederson Valei de Oliveira&#58; Contribuiu com a obten&#231;&#227;o e interpreta&#231;&#227;o dos dados&#44; participa&#231;&#227;o efetiva&#44; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Roberto Bueno Filho&#58; Contribuiu com a obten&#231;&#227;o e interpreta&#231;&#227;o dos dados&#44; participa&#231;&#227;o efetiva&#44; participa&#231;&#227;o em conduta terap&#234;utica dos casos estudados&#44; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Tamiris A&#46; Julio&#58; Contribuiu com a obten&#231;&#227;o e interpreta&#231;&#227;o dos dados&#44; participa&#231;&#227;o efetiva&#44; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Eduardo A&#46; Donadi&#58; Contribuiu com a obten&#231;&#227;o e interpreta&#231;&#227;o dos dados&#44; participa&#231;&#227;o efetiva&#44; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Aline Turatti&#58; Contribuiu com a obten&#231;&#227;o e interpreta&#231;&#227;o dos dados&#44; participa&#231;&#227;o efetiva&#44; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Norito Ishii&#58; Contribuiu com a obten&#231;&#227;o e interpreta&#231;&#227;o dos dados&#44; participa&#231;&#227;o efetiva&#44; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Takashi Hashimoto&#58; Contribuiu com a obten&#231;&#227;o e interpreta&#231;&#227;o dos dados&#44; participa&#231;&#227;o efetiva&#44; reda&#231;&#227;o do manuscrito&#44; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Ana Maria Roselino&#58; Contribuiu com a concep&#231;&#227;o e planejamento do estudo&#44; obten&#231;&#227;o e interpreta&#231;&#227;o dos dados&#44; reda&#231;&#227;o do manuscrito&#44; participa&#231;&#227;o efetiva&#44; revis&#227;o da literatura&#44; participa&#231;&#227;o em conduta terap&#234;utica dos casos estudados&#44; 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="par0120" 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">A associa&#231;&#227;o entre penfigoide bolhoso &#40;PB&#41; e les&#245;es de milia tem sido cada vez mais relatada&#44; mas sua preval&#234;ncia ainda n&#227;o havia sido relatada em uma popula&#231;&#227;o brasileira com PB&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Descrever a ocorr&#234;ncia e os achados cl&#237;nico&#8208;laboratoriais da associa&#231;&#227;o PB&#8208;milia em uma amostra da regi&#227;o sudeste brasileira&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Realizou-se estudo descritivo baseado nos prontu&#225;rios de 102 pacientes com PB&#46; Dados cl&#237;nicos e laboratoriais de pacientes com PB&#8208;milia foram obtidos&#46; IgE s&#233;rica total&#44; ensaios de <span class="elsevierStyleItalic">immunoblotting</span> com base em ant&#237;genos da zona da membrana basal e tipagem de alelos HLA&#8208;DQ foram realizados&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Les&#245;es de milia foram evidentes em oito &#40;7&#44;8&#37;&#41; pacientes com PB&#44; cinco do sexo masculino&#44; com idade entre 46 e 88 anos&#46; N&#237;veis elevados de IgE total foram determinados em sete &#40;87&#44;5&#37;&#41; de oito pacientes&#46; Em cinco dos oito pacientes&#44; o <span class="elsevierStyleItalic">immunoblotting</span> mostrou reatividade de IgG contra o dom&#237;nio BP180&#8208;NC16a&#44; mas n&#227;o contra col&#225;geno VII ou laminina&#8208;332&#59; tamb&#233;m revelou reatividade contra o dom&#237;nio C&#8208;terminal de BP180 ou LAD&#8208;1&#44; ou ambos em quatro deles&#46; Os alelos <span class="elsevierStyleItalic">HLA&#8208;DQB1</span>&#42;03&#58;01 e <span class="elsevierStyleItalic">HLA&#8208;DQA1</span>&#42;05&#58;05 foram identificados em tr&#234;s desses cinco pacientes com PB&#8208;milia&#46; Al&#233;m disso&#44; tr&#234;s dos cinco casos apresentaram o grupo al&#233;lico <span class="elsevierStyleItalic">HLA-DQB1&#42;</span>06&#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">O HLA foi determinado em cinco pacientes&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#245;es</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A forma&#231;&#227;o de milia em pacientes com PB parece ser menos incomum do que anteriormente admitido&#46; Os dados laboratoriais revelaram aumento de IgE&#59; autoanticorpos contra o dom&#237;nio C&#8208;terminal de BP180 ou LAD&#8208;1&#44; ou ambos&#59; e o grupo al&#233;lico <span class="elsevierStyleItalic">HLA-DQB1&#42;</span>06&#44; descrito na associa&#231;&#227;o PB&#8208;milia&#46; A determina&#231;&#227;o cuidadosa de anticorpos contra mol&#233;culas da zona da membrana basal e a caracteriza&#231;&#227;o do HLA em diferentes popula&#231;&#245;es podem fornecer mais informa&#231;&#245;es sobre essa associa&#231;&#227;o&#46;</p></span>"
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          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41;&#44; Imunofluoresc&#234;ncia direta em bi&#243;psia de pele mostrando fluoresc&#234;ncia linear de IgG na zona da membrana basal &#40;<span class="elsevierStyleItalic">seta branca</span>&#59; paciente 2&#41;&#46; Imunofluoresc&#234;ncia&#44; 400<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>&#46; &#40;B&#41;&#44; Imunofluoresc&#234;ncia indireta utilizando 1M&#8208;NaCl&#8208;salt&#8208;split skin mostra fluoresc&#234;ncia de IgG no lado epid&#233;rmico de clivagem &#40;paciente&#160;5&#41;&#46; Imunofluoresc&#234;ncia&#44; 400<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figura 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1722
            "Ancho" => 2928
            "Tamanyo" => 425533
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Immunoblotting</span> utilizando BP180&#8208;NC16a &#40;A&#41; C&#8208;terminal BP180 &#40;B&#41; e c&#233;lulas HaCaT &#40;C&#41; com amostras de soro&#46; Para resultados positivos&#44; procure a prote&#237;na de refer&#234;ncia &#40;PR&#41; de&#58; soro do paciente PB &#40;penfigoide bolhoso&#41; &#40;A&#41;&#44; MMP&#44; soro do paciente com penfigoide das membranas mucosas &#40;B&#41; e LAD&#58; soro do paciente com dermatose IgA linear &#40;C&#41;&#46;</p>"
        ]
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      4 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabela 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabela "
            "rol" => "short"
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        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&#250;mero do paciente&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">Sexo&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">Idade &#40;anos&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dura&#231;&#227;o da doen&#231;a &#40;meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Distribui&#231;&#227;o das les&#245;es&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">Hist&#243;rico m&#233;dico e comorbidades&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">Medicamentos em uso no in&#237;cio das les&#245;es de PB&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">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">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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">Tronco&#44; membros&#44; m&#227;os e p&#233;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Erisipela recorrente&#44; hipertens&#227;o&#44; dislipidemia e c&#226;ncer de bexiga ressecado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enalapril&#44; amlodipina&#44; sinvastatina&#44; carvedilol e omeprazol&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">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">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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">Tronco&#44; abdome e membros&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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 da tireoide&#44; hipertens&#227;o&#44; diabetes <span class="elsevierStyleItalic">mellitus</span> tipo 2 e hist&#243;ria de histoplasmose pulmonar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Metformina&#44; losartana&#44; aspirina&#44; ramipril&#44; omeprazol e atorvastatina&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">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">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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">Tronco e membros inferiores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipertens&#227;o&#44; diabetes <span class="elsevierStyleItalic">mellitus</span> tipo 2 e acidente vascular encef&#225;lico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aspirina&#44; carvedilol&#44; furosemida&#44; dinitrato de isossorbida&#44; omeprazol&#44; NPH e insulina&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">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">Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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">Pesco&#231;o&#44; tronco e membros&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipertens&#227;o&#44; hipotireoidismo&#44; hiperparatireoidismo e asma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Losartana&#44; amlodipina&#44; levotiroxina&#44; ranitidina&#44; duloxetina&#44; pregabalina&#44; primidona&#44; carbonato de c&#225;lcio&#44; pidolato de magn&#233;sio&#44; cloreto de pot&#225;ssio&#44; &#225;cido f&#243;lico e vitamina E&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">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">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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">Tronco e m&#227;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipertens&#227;o&#44; diabetes <span class="elsevierStyleItalic">mellitus</span> tipo 2&#44; dislipidemia e acidente vascular encef&#225;lico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hidroclorotiazida&#44; atenolol&#44; aspirina&#44; fenito&#237;na&#44; metformina&#44; sinvastatina&#44; diosmina&#44; indapamida e cilostazol&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">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">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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">Couro cabeludo&#44; face&#44; tronco&#44; abd&#244;men e membros superiores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipertens&#227;o&#44; dislipidemia&#44; tabagismo&#44; alcoolismo&#44; infec&#231;&#227;o urin&#225;ria de repeti&#231;&#227;o&#44; acidente vascular encef&#225;lico e epis&#243;dio de psicose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hidroclorotiazida&#44; sinvastatina&#44; clopidogrel&#44; nortriptilina e amiodarona&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">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">Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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">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">Regi&#227;o axilar&#44; coxas e p&#233;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cefaleia cr&#244;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Desogestrel&#44; etinilestradiol e metamizol&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">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">Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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">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">Mucosa oral&#44; t&#243;rax&#44; m&#227;os e p&#233;s e regi&#227;o inguinal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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 Parkinson e dem&#234;ncia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prolopa&#44; domperidona&#44; omeprazol&#44; doxiciclina e nicotinamida&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Dados demogr&#225;ficos e cl&#237;nicos de pacientes com associa&#231;&#227;o PB&#8208;milia</p>"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">PB&#44; penfigoide bolhoso&#59; IFD&#44; imunofluoresc&#234;ncia direta com deposi&#231;&#227;o de fluoresc&#234;ncia linear ao longo da zona da membrana basal&#59; SSS&#8208;IFI&#44; m&#233;todo <span class="elsevierStyleItalic">salt&#8208;split skin</span> na imunofluoresc&#234;ncia indireta com fluoresc&#234;ncia linear na clivagem epid&#233;rmica&#59; fluoresc&#234;ncia IgA negativa&#46; N&#46;D&#46;&#44; n&#227;o dispon&#237;vel&#46;</p>"
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            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&#250;mero do paciente&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">Caracter&#237;sticas histopatol&#243;gicas na bi&#243;psia de pele&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">IFD&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">SSS&#8208; IFI&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">IgE s&#233;rico &#40;kU&#47;mL&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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">Anti&#8208;BP180 &#40;U&#47;mL&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&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">Anti&#8208;BP230 &#40;U&#47;mL&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&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">Achados de <span class="elsevierStyleItalic">Immunoblotting</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Alelos<span class="elsevierStyleItalic">HLA&#8208;DQ</span>&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">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">Bolha subepid&#233;rmica com eosin&#243;filos dentro da bolha e na derme superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IgG e C3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IgG e C3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62; 5000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">128&#44;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">137&#44;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">Dom&#237;nio BP180&#8208;NC16a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&#46;D&#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">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">Descolamento epid&#233;rmico&#59; infiltrado inflamat&#243;rio com linf&#243;citos&#44; neutr&#243;filos e eosin&#243;filos na derme superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C3 e fibrinog&#234;nio&#59; IgG negativo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IgG e C3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62; 5000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;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">4&#44;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">Dom&#237;nio C&#8208;terminal BP180 e LAD&#8208;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">N&#46;D&#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">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">Epiderme exibindo leve espongiose&#46; Discreto infiltrado inflamat&#243;rio linfocit&#225;rio intersticial na derme superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negativo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IgG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">782&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&#44;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;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">Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&#46;A&#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">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">Foco de descolamento epid&#233;rmico&#46; Infiltrado inflamat&#243;rio perivascular e intersticial leve com linf&#243;citos na derme superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IgG e C3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IgG e C3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62; 5000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">159&#44;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">72&#44;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">Dom&#237;nio BP180&#8208;NC16a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">DQA1&#42;</span> 01&#58;02&#47;02&#58;01&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">DQB1&#42;</span> 02&#58;02&#47;06&#58;02&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">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">N&#46;D&#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">IgG e C3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IgG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">252&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">107&#44;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">4&#44;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">BP180&#8208;NC16a&#44; dom&#237;nio C&#8208;terminal BP180&#44; e LAD&#8208;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"><span class="elsevierStyleItalic">DQA1&#42;</span> 01&#58;01&#47;05&#58;05&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">DQB1&#42;</span> 03&#58;01&#47;05&#58;01&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">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">Ves&#237;cula subepid&#233;rmica com fibrina&#44; neutr&#243;filos e linf&#243;citos&#46; Moderado infiltrado linfocit&#225;rio perianexial&#44; perivascular e intersticial na derme superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negativo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IgG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1286&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&#44;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">68&#44;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">BP230&#59; dom&#237;nio C&#8208;terminal BP180&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">DQA1&#42;</span> 01&#58;02&#47;02&#58;01&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">DQB1&#42;</span> 02&#58;02&#47;06&#58;02&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">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">Ves&#237;cula subepid&#233;rmica&#59; infiltrado inflamat&#243;rio com numerosos eosin&#243;filos e linf&#243;citos na derme superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&#46;D&#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">IgG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&#44;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">98&#44;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">1&#44;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">BP180&#8208;NC16a&#44; dom&#237;nio C&#8208;terminal BP180&#44; e LAD&#8208;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"><span class="elsevierStyleItalic">DQA1&#42;</span> 05&#58;05&#47;05&#58;05&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">DQB1&#42;</span> 03&#58;01&#47;03&#58;01&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">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">Ves&#237;cula subepid&#233;rmica com alguns eosin&#243;filos em seu interior&#59; ceratin&#243;citos necr&#243;ticos no assoalho da clivagem&#46; Infiltrado inflamat&#243;rio intersticial e perivascular com predom&#237;nio de linf&#243;citos e eosin&#243;filos na derme superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negativo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IgG e C3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">427&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">169&#44;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">23&#44;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">Dom&#237;nio BP180&#8208;NC16a e LAD&#8208;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"><span class="elsevierStyleItalic">DQA1&#42;</span> 01&#58;03&#47;05&#58;05&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">DQB1&#42;</span> 03&#58;01&#47;06&#58;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Varia&#231;&#227;o normal de IgE s&#233;rica &#60;<span class="elsevierStyleHsp" style=""></span>100&#160;kU&#47;mL&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Autoanticorpos anti&#8208;BP180 e anti&#8208;BP230&#58; valor de corte&#58; 9&#160;U&#47;mL &#40;ELISA&#44; MBL&#44; Jap&#227;o&#41;&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Dados laboratoriais de pacientes com associa&#231;&#227;o PB&#8208;milia</p>"
        ]
      ]
    ]
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                      "titulo" => "HLA&#8208;C&#42;17&#44; DQB1&#42;03&#58;01 DQA1&#42;01&#58;03 and DQA1&#42;05&#58;05 alleles associated to bullous pemphigoid in Brazilian Population"
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Informação do artigo
ISSN: 26662752
Idioma original: Português
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