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h&#225; alta propor&#231;&#227;o de c&#233;lulas T CD4<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>com aumento de citocinas tipo 1&#46; Por outro lado&#44; a HV mostra predomin&#226;ncia de c&#233;lulas T CD8<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>com citocinas tipo 2&#46; Os dados mencionados demonstram as intera&#231;&#245;es imunopatol&#243;gicas entre as citocinas tipo 2 e tipo 1 e produtos de macr&#243;fagos ativados &#40;monocinas&#41; na hansen&#237;ase&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">No entanto&#44; certo subconjunto de c&#233;lulas T mostrou produzir citocinas que n&#227;o podem ser classificadas de acordo com o esquema Th1&#8208;Th2&#46; A interleucina &#40;IL&#41;&#8208;17 est&#225; entre essas citocinas&#44; e as c&#233;lulas T produtoras de IL&#8208;17 foram denominadas c&#233;lulas Th17&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">A IL&#8208;17A &#233; uma prote&#237;na que em seres humanos &#233; codificada pelo gene IL&#8208;17A&#46; &#201; uma citocina pr&#243;&#8208;inflamat&#243;ria&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">7</span></a> Originalmente&#44; a IL&#8208;17A deveria ser produzida exclusivamente por c&#233;lulas T&#44; mas tamb&#233;m &#233; secretada por muitas outras c&#233;lulas&#44; incluindo c&#233;lulas dendr&#237;ticas &#40;CD&#41;&#44; macr&#243;fagos&#44; c&#233;lulas <span class="elsevierStyleItalic">natural killer</span> &#40;NK&#41; e c&#233;lulas &#947;&#948;&#8208;T&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">A IL&#8208;17A atua em c&#233;lulas estruturais&#44; como c&#233;lulas epiteliais&#44; fibroblastos e queratin&#243;citos em v&#225;rios tecidos&#44; incluindo a pele&#46; Essas c&#233;lulas expressam o receptor de IL&#8208;17 e produzem muitas citocinas necess&#225;rias para a resposta inflamat&#243;ria&#44; como o fator estimulador de col&#244;nias de granul&#243;citos &#40;GCSF&#44; do ingl&#234;s <span class="elsevierStyleItalic">granulocyte colony&#8208;stimulating factor</span>&#41; e IL&#8208;6&#44; bem como quimiocinas para atrair neutr&#243;filos e macr&#243;fagos para os tecidos inflamados&#46; Essas c&#233;lulas inflamat&#243;rias &#40;neutr&#243;filos e macr&#243;fagos&#41; podem tanto eliminar a infec&#231;&#227;o como iniciar um processo patog&#234;nico&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Al&#233;m disso&#44; a liga&#231;&#227;o da IL&#8208;17A ao receptor de IL&#8208;17 causa mudan&#231;as conformacionais importantes que possibilitam a liga&#231;&#227;o de adaptadores de sinaliza&#231;&#227;o&#44; como os fatores associados ao receptor de TNF &#40;TRAFs&#44; do ingl&#234;s <span class="elsevierStyleItalic">TNF&#8208;receptor associated factors</span>&#41;&#46; A liga&#231;&#227;o desses adaptadores de sinaliza&#231;&#227;o desencadeia a ativa&#231;&#227;o de v&#225;rias vias de sinaliza&#231;&#227;o&#44; incluindo o fator nuclear kappa B &#40;NF&#8208;&#954;B&#41; e vias da prote&#237;na&#8208;quinase ativada por mit&#243;geno &#40;MAPK&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">9</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">A ativa&#231;&#227;o dessas vias leva &#224; produ&#231;&#227;o de muitas citocinas inflamat&#243;rias&#44; como IL&#8208;1&#946;&#44; fator de necrose tumoral alfa &#40;TNF&#8208;&#945;&#41; e quimiocinas&#44; que atraem macr&#243;fagos&#44; bem como produtos antimicrobianos como mucinas e defensinas&#46; Por meio de seus efeitos inflamat&#243;rios&#44; esses produtos ajudam na elimina&#231;&#227;o de muitos pat&#243;genos estranhos&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Foi demonstrado que a IL&#8208;17A protege o corpo humano contra v&#225;rias infec&#231;&#245;es bacterianas e f&#250;ngicas causadas por pat&#243;genos invasores&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">9</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">O objetivo do presente estudo foi esclarecer o hipot&#233;tico papel da IL&#8208;17A na patog&#234;nese da hansen&#237;ase&#44; por meio da an&#225;lise do polimorfismo do gene IL&#8208;17A &#40;rs2275913&#41;&#44; al&#233;m de seus n&#237;veis s&#233;ricos em pacientes com hansen&#237;ase&#44; e correlacionar os resultados obtidos com diferentes aspectos cl&#237;nicos da hansen&#237;ase nos pacientes investigados&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Materiais e m&#233;todos</span><p id="par0060" class="elsevierStylePara elsevierViewall">O presente trabalho foi um estudo de caso&#8208;controle&#46; Foi realizado em 60 pacientes com tipos variados de hansen&#237;ase e 29 volunt&#225;rios saud&#225;veis pareados por idade e sexo&#44; sem hist&#243;ria pregressa ou familiar de hansen&#237;ase &#40;grupo controle&#41;&#46; Os pacientes com hansen&#237;ase e o grupo controle foram selecionados no Ambulat&#243;rio de Dermatologia e Hansen&#237;ase&#44; Menoufia Teaching and University Hospitals&#46; A parte laboratorial do estudo foi realizada no Departamento de Microbiologia e Imunologia&#44; Faculdade de Medicina&#44; Menoufia University&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">O estudo foi aprovado pelo Comit&#234; de &#201;tica em Direitos Humanos em Pesquisa&#44; Menoufia University&#46; O termo de consentimento informado por escrito foi assinado por cada participante ap&#243;s a informa&#231;&#227;o sobre o estudo&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Foram inclu&#237;dos pacientes de ambos os sexos com hansen&#237;ase confirmada por meio do aspecto cl&#237;nico das les&#245;es&#44; baciloscopia &#40;SSS&#44; do ingl&#234;s <span class="elsevierStyleItalic">slit skin smear</span>&#41; positiva pr&#233;via e&#47;ou avalia&#231;&#227;o histopatol&#243;gica&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Indiv&#237;duos com qualquer uma das seguintes condi&#231;&#245;es foram exclu&#237;dos deste estudo&#58; 1&#8208; doen&#231;as sist&#234;micas &#40;por exemplo&#44; diabetes <span class="elsevierStyleItalic">mellitus</span>&#44; cirrose&#44; infec&#231;&#227;o sist&#234;mica&#44; insufici&#234;ncia renal&#44; doen&#231;a do col&#225;geno ou neoplasia maligna&#41;&#59; 2&#8208; endocrinopatias &#40;como s&#237;ndrome de Cushing&#44; hiper&#8208; e hipotireoidismo&#41;&#59; 3&#8208; em uso de medicamentos anti&#8208;inflamat&#243;rios ou medicamentos hormonais&#44; como esteroides&#46; 4&#8208; gravidez e lacta&#231;&#227;o&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Uma ficha foi aberta para todos os pacientes&#44; incluindo nome&#44; idade&#44; sexo&#44; resid&#234;ncia&#44; ocupa&#231;&#227;o e hist&#243;rico da doen&#231;a hans&#234;nica&#46; Para avaliar o n&#237;vel socioecon&#244;mico &#40;NSE&#41;&#44; utilizou&#8208;se a escala que inclui sete dom&#237;nios &#40;escolaridade e cultural&#59; ocupa&#231;&#227;o&#59; bens da fam&#237;lia&#59; fam&#237;lia&#59; saneamento dom&#233;stico&#59; econ&#244;mico&#59; e assist&#234;ncia &#224; sa&#250;de&#41;&#46; Foi perguntado a cada participante sobre ocupa&#231;&#245;es&#44; renda e n&#237;veis educacionais&#46; O escore total do NSE &#233; 84&#46; NSE alto foi indicado como pelo menos 70&#37; &#40;59 a 84&#41;&#59; n&#237;vel m&#233;dio&#44; 40&#37; a menos de 70&#37; &#40;34 a 58&#41;&#59; e n&#237;vel baixo como menos de 40&#37; &#40;menos de 34&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">11</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Foi realizado exame dermatol&#243;gico incluindo avalia&#231;&#227;o cl&#237;nica completa das les&#245;es cut&#226;neas para determinar a distribui&#231;&#227;o&#44; n&#250;mero e&#44; consequentemente&#44; a classifica&#231;&#227;o cl&#237;nica&#46; Al&#233;m disso&#44; foi realizado exame neurol&#243;gico para detectar poss&#237;veis nervos afetados&#46; Os pacientes com hansen&#237;ase avaliados foram categorizados pelos crit&#233;rios de Madrid &#40;1953&#41; em&#58; HT&#44; HB ou dimorfa e HV&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">12</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Sob condi&#231;&#227;o de assepsia completa&#44; 5<span class="elsevierStyleHsp" style=""></span>mL de sangue foram obtidos de cada indiv&#237;duo e divididos em duas partes&#46; A primeira parte &#40;2<span class="elsevierStyleHsp" style=""></span>mL&#41; foi mantida em tubo simples&#44; deixada a 37<span class="elsevierStyleHsp" style=""></span>&#176;C por 30 minutos para coagular&#44; depois centrifugada a 4000<span class="elsevierStyleHsp" style=""></span>rpm por 10 minutos&#46; O soro obtido foi separado em al&#237;quotas e mantido a<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>80<span class="elsevierStyleHsp" style=""></span>&#176;C at&#233; o momento da an&#225;lise para determina&#231;&#227;o do n&#237;vel s&#233;rico de IL&#8208;17A utilizando kits de ELISA &#40;Neo Bio science Technology Co&#46;&#44; Ltd&#44; Shenzhen&#44; China&#41; de acordo com as instru&#231;&#245;es do fabricante&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">A segunda parte &#40;3<span class="elsevierStyleHsp" style=""></span>mL&#41; foi transferida imediatamente para tubo vacutainer com EDTA e armazenada para extra&#231;&#227;o de DNA&#46; A extra&#231;&#227;o de DNA foi feita utilizando o mini kit <span class="elsevierStyleItalic">Gene JET&#8482; Whole Blood Genomic DNA Purification</span> &#40;THERMO SCIENTIFIC&#44; EU&#47;Litu&#226;nia&#41;&#44; seguindo as instru&#231;&#245;es do fabricante&#46; A genotipagem do SNP para IL17A &#8208;197G&#92;A &#40;rs2275913&#41; foi obtida pela an&#225;lise de polimorfismo de fragmentos de restri&#231;&#227;o utilizando a rea&#231;&#227;o em cadeia da polimerase &#40;PCR&#8208;RFLP&#41;&#46; As sequ&#234;ncias de <span class="elsevierStyleItalic">primers</span> para IL17A&#8208;197G&#92;A foram 5&#8217;&#8208;AACAAGTAAGAATGAAAAGAGGACATGGT&#8208;3&#8217;&#40;<span class="elsevierStyleItalic">sense</span>&#41; e 5&#8217;&#8208; CCCCCAATGAGGTCATAGAAGAATC&#8208;3&#8217;&#40;<span class="elsevierStyleItalic">anti&#8208;sense</span>&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">A amplifica&#231;&#227;o de PCR foi realizada em um volume de 30<span class="elsevierStyleHsp" style=""></span>&#956;L de mistura contendo 100 ng de DNA gen&#244;mico&#44; 1&#44;0<span class="elsevierStyleHsp" style=""></span>&#956;M de cada <span class="elsevierStyleItalic">primer</span>&#44; 200<span class="elsevierStyleHsp" style=""></span>&#956;M de cada dNTP&#44; 2&#44;0<span class="elsevierStyleHsp" style=""></span>mM de MgCl<span class="elsevierStyleInf">2</span>&#44; 3<span class="elsevierStyleHsp" style=""></span>&#956;L de tamp&#227;o de PCR 10<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>e 1&#44;5 U Taq DNA polimerase &#40;Invitrogen Life Technologies&#44; Grand Island&#44; NY&#44; EUA&#41;&#46; As enzimas de restri&#231;&#227;o XagI &#40;THERMO SCIENTIFIC&#44; EU&#47;Litu&#226;nia&#41; foram usadas para diferenciar os gen&#243;tipos IL17A&#8208;197G&#92;A &#40;rs2275913&#41; &#8211; 102&#44; 68&#44; 34 pb&#46; O produto de PCR e a enzima foram bem misturados e incubados a 37<span class="elsevierStyleHsp" style=""></span>&#176;C durante 1&#44;5 hora&#46; O padr&#227;o de migra&#231;&#227;o dos produtos da digest&#227;o em gel de agarose a 3&#37; possibilitou a identifica&#231;&#227;o dos gen&#243;tipos IL17A&#8208;197G&#92;A&#46; A genotipagem foi realizada &#224;s cegas e em quantidades iguais de casos e controles&#46; O gen&#243;tipo G &#40;68<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>34 pb&#41;&#44; o gen&#243;tipo A &#40;102 pb&#41; e o AG &#40;102&#44; 68&#44; 34 pb&#41; foram identificados&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">13</span></a></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">An&#225;lise estat&#237;stica</span><p id="par0105" class="elsevierStylePara elsevierViewall">Os dados coletados foram analisados estatisticamente pelo <span class="elsevierStyleItalic">software</span> SPSS &#40;vers&#227;o 20&#41; em computador compat&#237;vel com IBM&#46; Duas formas de an&#225;lise estat&#237;stica foram realizadas&#58; 1&#41; estat&#237;stica descritiva&#58; foram expressas como m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desvio padr&#227;o &#40;X<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&#41; bem como mediana e intervalo para dados quantitativos ou n&#250;mero e porcentagem &#40;N<span class="elsevierStyleSup">o</span> e &#37;&#41; para dados qualitativos&#59; 2&#41; estat&#237;stica anal&#237;tica&#58; foram utilizados os testes Qui&#8208;Quadrado &#40;&#967;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">2</span></a>&#41;&#44; Mann&#8208;Whitney&#44; Kruskal&#8208;Wallis e Z&#59; p &#8804; 0&#44;05 foi considerado estatisticamente significativo&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Resultados</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Dados sociodemogr&#225;ficos e cl&#237;nicos</span><p id="par0110" class="elsevierStylePara elsevierViewall">A idade dos casos selecionados variou de 19 a 82 anos&#44; dos quais 44 &#40;73&#44;3&#37;&#41; eram homens e 16 &#40;26&#44;7&#37;&#41; mulheres&#44; e 83&#37; dos pacientes estudados eram da zona rural&#46; Quinze &#40;25&#37;&#41; pacientes com hansen&#237;ase tinham HT&#44; 25 &#40;41&#44;7&#37;&#41; pacientes tinham HV e 20 &#40;33&#44;3&#37;&#41; casos tinham BV&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Em compara&#231;&#227;o aos controles&#44; a maioria dos pacientes com hansen&#237;ase &#40;90&#37;&#41; tinha NSE significativamente baixo &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e 13&#44;3&#37; deles tinham hist&#243;ria familiar positiva de hansen&#237;ase &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;039&#59; <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">N&#237;veis s&#233;ricos de IL&#8208;17A</span><p id="par0120" class="elsevierStylePara elsevierViewall">N&#237;veis s&#233;ricos de IL&#8208;17A significativamente mais altos foram observados nos pacientes com hansen&#237;ase &#40;4&#44;84<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;79&#41; do que no grupo controle &#40;2&#44;04<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;25&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;034&#59; <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#44; que foram significativamente maiores no grupo HT &#40;4&#44;52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;87&#41; do que no grupo HV &#40;2&#44;91<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;69&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;017&#59; <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Rela&#231;&#227;o entre os n&#237;veis s&#233;ricos de IL&#8208;17A e dados cl&#237;nicos em pacientes com hansen&#237;ase</span><p id="par0125" class="elsevierStylePara elsevierViewall">Os n&#237;veis s&#233;ricos de IL&#8208;17A n&#227;o foram afetados por quaisquer dados pessoais ou cl&#237;nicos nos casos de hansen&#237;ase estudados&#44; exceto pelo sexo&#44; pois n&#237;veis s&#233;ricos de IL&#8208;17A significativamente mais elevados foram relatados em pacientes com hansen&#237;ase do sexo feminino do que no sexo masculino &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;007&#59; <a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Gen&#243;tipos e alelos de IL&#8208;17 &#40;rs2275913A&#47;G&#41;</span><p id="par0130" class="elsevierStylePara elsevierViewall">O estudo do SNP de IL&#8208;17A &#40;rs2275913A&#47;G&#59; <a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41; mostrou que havia diferen&#231;a estatisticamente n&#227;o significativa entre pacientes com hansen&#237;ase e grupo controle em rela&#231;&#227;o aos gen&#243;tipos de IL&#8208;17A &#40;rs2275913A&#47;G&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;898&#41; e distribui&#231;&#227;o de alelos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;625&#59; <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46; Entretanto&#44; foram demonstradas diferen&#231;as significativas entre os pacientes com os tr&#234;s tipos de hansen&#237;ase em rela&#231;&#227;o &#224;s distribui&#231;&#245;es percentuais dos gen&#243;tipos de IL&#8208;17A &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e os alelos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#44; uma vez que o gen&#243;tipo GG do IL&#8208;17A &#40;rs2275913A&#47;G&#41; al&#233;m do alelo G foram associados significativamente com HV&#44; enquanto o gen&#243;tipo AG estava significativamente associado a casos de HT &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Rela&#231;&#227;o entre gen&#243;tipos de IL&#8208;17A e dados cl&#237;nicos em pacientes com hansen&#237;ase</span><p id="par0135" class="elsevierStylePara elsevierViewall">Diferen&#231;as n&#227;o significativas foram encontradas entre os gen&#243;tipos de IL&#8208;17A &#40;rs2275913A&#47;G&#41; em rela&#231;&#227;o aos dados pessoais e cl&#237;nicos de pacientes com hansen&#237;ase&#44; exceto grau de incapacidade e SSS&#44; pois uma porcentagem maior de incapacidade de grau 2 e SSS positiva foram associadas significativamente com o gen&#243;tipo GG de IL&#8208;17A &#40;rs2275913A&#47;G&#41; quando comparadas aos gen&#243;tipos AG e GG &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;030 e 0&#44;005&#59; respectivamente&#59; <a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Rela&#231;&#227;o entre os n&#237;veis s&#233;ricos de IL&#8208;17A e gen&#243;tipos de IL&#8208;17A &#40;rs2275913A&#47;G&#41;</span><p id="par0140" class="elsevierStylePara elsevierViewall">Em pacientes com hansen&#237;ase&#44; havia rela&#231;&#227;o estatisticamente significativa entre os gen&#243;tipos de IL&#8208;17A &#40;rs2275913A&#47;G&#41; e os n&#237;veis s&#233;ricos de IL&#8208;17A&#44; pois os n&#237;veis mais altos foram encontrados em portadores do gen&#243;tipo AG de IL&#8208;17A &#40;rs2275913A&#47;G&#41; e os n&#237;veis mais baixos foram encontrados em portadores do gen&#243;tipo AA &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#46; Entretanto&#44; no grupo controle&#44; foi encontrada rela&#231;&#227;o n&#227;o significante &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;505&#59; <a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discuss&#227;o</span><p id="par0145" class="elsevierStylePara elsevierViewall">Em v&#225;rias condi&#231;&#245;es patog&#234;nicas&#44; a IL&#8208;17A pode eliminar a infec&#231;&#227;o e iniciar a rea&#231;&#227;o inflamat&#243;ria que pode ser mediada pela via NF&#8208;&#954;B&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">9</span></a> via produ&#231;&#227;o de muitas citocinas inflamat&#243;rias como TNF&#8208;&#945;&#44; IL&#8208;1&#946;&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">10</span></a> G&#8208;CSF e IL&#8208;6&#44; bem como quimiotaxia de macr&#243;fagos e neutr&#243;filos para os tecidos inflamados&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">De acordo com esses dados&#44; foi demonstrado que os n&#237;veis circulantes de IL&#8208;17A apresentaram valores m&#233;dios significativamente mais altos em pacientes com hansen&#237;ase do que os controles e em HT do que em HV&#46; Esse n&#237;vel alto pode representar o mecanismo de defesa do organismo contra a infec&#231;&#227;o pelo bacilo da hansen&#237;ase&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Em concord&#226;ncia com o resultado do presente estudo&#44; Sakdiah et al&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">14</span></a> estudaram 40 pacientes indon&#233;sios com hansen&#237;ase <span class="elsevierStyleItalic">versus</span> 40 controles&#46; Eles demonstraram que os n&#237;veis s&#233;ricos de IL&#8208;17 em pacientes com hansen&#237;ase eram maiores do que nos controles&#46; Al&#233;m disso&#44; Santos et al&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a> investigaram 51 pacientes brasileiros com hansen&#237;ase e 23 controles&#46; Os autores revelaram que as concentra&#231;&#245;es de IL&#8208;17A eram mais elevadas em pacientes com HT do que HV e controles&#46; Al&#233;m disso&#44; eles demonstraram mais c&#233;lulas CD4<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#47;IL&#8208;17A<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>em les&#245;es de pele de pacientes com HT do que em pacientes com HV&#46; Santos et al&#46; relataram uma associa&#231;&#227;o significativa entre as c&#233;lulas Th17 e uma resposta inflamat&#243;ria efetiva nas formas PB&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">No presente estudo&#44; foi demonstrado um n&#237;vel s&#233;rico significativamente mais alto de IL&#8208;17A em pacientes do sexo feminino do que no sexo masculino&#46; Tsuboi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a> estudaram 409 pacientes &#40;200 homens&#44; 208 mulheres&#41; no Jap&#227;o e encontraram n&#237;veis s&#233;ricos elevados de IL&#8208;17A em mulheres com depress&#227;o&#46; Portanto&#44; pode&#8208;se especular que o aumento dos n&#237;veis s&#233;ricos de IL&#8208;17A em pacientes do sexo feminino pode ser explicado pelo fato de essas mulheres estarem sofrendo de altera&#231;&#245;es psiqui&#225;tricas&#44; incluindo depress&#227;o resultante de seu estado de adoecimento&#46; Al&#233;m disso&#44; as mulheres s&#227;o mais suscet&#237;veis a desenvolver mais altera&#231;&#245;es inflamat&#243;rias e autoimunes do que os homens&#44; e o aumento dos n&#237;veis s&#233;ricos de IL&#8208;17 pode sinalizar para isso antes mesmo do aparecimento do quadro cl&#237;nico&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Embora <span class="elsevierStyleItalic">M&#46; leprae</span> possa infectar muitas pessoas&#44; poucas adoecem&#44; o que pode ser atribu&#237;do&#44; em parte&#44; &#224; influ&#234;ncia da heran&#231;a gen&#233;tica na resposta imune&#46; Acredita&#8208;se que muitos SNPs est&#227;o ligados &#224; produ&#231;&#227;o de citocinas e quimiocinas que foram implicadas nas formas cl&#237;nicas de hansen&#237;ase e epis&#243;dios reacionais&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">17&#44;18</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">O presente estudo mostrou diferen&#231;a estatisticamente n&#227;o significativa entre pacientes com hansen&#237;ase e grupo controle quanto aos gen&#243;tipos de IL&#8208;17 &#40;rs2275913A&#47;G&#41; e distribui&#231;&#227;o de alelos&#46; No entanto&#44; a compara&#231;&#227;o entre os subgrupos de hansen&#237;ase &#40;HV&#44; HT e BV&#41; revelou que o gen&#243;tipo IL&#8208;17 &#40;rs2275913A&#47;G&#41; GG&#44; al&#233;m do alelo G&#44; estavam associados significativamente com HV&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Em concord&#226;ncia com os resultados do presente estudo&#44; Aquino et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">19</span></a> estudaram 150 pacientes brasileiros com hansen&#237;ase e 150 contatos domiciliares&#46; Eles descobriram que as frequ&#234;ncias genot&#237;picas apresentavam diferen&#231;as n&#227;o significativas nos pacientes com hansen&#237;ase em geral e os controles&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">19</span></a> Al&#233;m disso&#44; Escamilla&#8208;Tilch et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">20</span></a> investigaram 75 pacientes mexicanos mesti&#231;os com hansen&#237;ase <span class="elsevierStyleItalic">versus</span> 69 controles&#46; Sessenta e dois pacientes foram classificados como HV&#44; dois como HT&#44; dois como BV e nove como borderline&#46; Eles n&#227;o encontraram associa&#231;&#227;o entre os SNPs do gene IL&#8208;17A &#40;rs2275913A&#47;G&#41; e hansen&#237;ase&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">20</span></a> Portanto&#44; o presente estudo confirmou a evid&#234;ncia de falta de rela&#231;&#227;o entre o polimorfismo do gene IL&#8208;17A &#40;rs2275913A&#47;G&#41; e a suscetibilidade &#224; hansen&#237;ase&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Em rela&#231;&#227;o aos subgrupos de hansen&#237;ase&#44; embora tenha sido relatada uma associa&#231;&#227;o significativa entre o alelo G de IL&#8208;17A &#40;rs2275913A&#47;G&#41; e o gen&#243;tipo GG com HV&#44; Escamilla&#8208;Tilch et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">20</span></a> n&#227;o encontraram essa associa&#231;&#227;o&#46; Essa diferen&#231;a pode ser explicada com base em fatores ambientais e socioecon&#244;micos que podem influenciar o desenvolvimento de diferentes doen&#231;as&#46; Al&#233;m disso&#44; Escamilla&#8208;Tilch et al&#46; investigaram apenas quatro casos &#40;dois como HT e dois como BV&#41; <span class="elsevierStyleItalic">versus</span> 62 com HV&#44; e esse tamanho de amostra pode n&#227;o ser adequado para avalia&#231;&#227;o estat&#237;stica&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">20</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">No presente estudo&#44; observou&#8208;se que maior porcentagem de incapacidade grau 2 e baciloscopia positiva estavam significativamente associadas ao gen&#243;tipo GG de IL&#8208;17A &#40;rs2275913A&#47;G&#41;&#44; confirmando que o estudo atual demonstrou maior predomin&#226;ncia do gen&#243;tipo GG nos pacientes com HV&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Entre os gen&#243;tipos de IL&#8208;17 &#40;rs2275913A&#47;G&#41; estudados&#44; os portadores do gen&#243;tipo AG demonstraram os n&#237;veis s&#233;ricos mais elevados de IL&#8208;17&#46; Isso pode ser esclarecido pela predomin&#226;ncia do gen&#243;tipo AG nos casos de HT estudados no presente estudo&#44; que &#233; caracterizado por boa imunidade e alta resposta imune mediada por c&#233;lulas&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Entretanto&#44; Aquino et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">19</span></a> mostraram que o gen&#243;tipo AA de IL&#8208;17A &#40;rs2275913&#41; estava relacionado a n&#237;veis s&#233;ricos elevados de IL&#8208;17A&#46; Essa diferen&#231;a pode ser atribu&#237;da a fatores &#233;tnicos&#47;raciais e gen&#233;ticos&#46; Aquino et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">19</span></a> estudaram uma popula&#231;&#227;o parda do sul do Brasil&#59; por&#233;m o presente estudo investigou a popula&#231;&#227;o eg&#237;pcia&#44; que pertence &#224; ra&#231;a africana&#46; De acordo com a SNPedia para IL&#8208;17A &#40;rs2275913&#41;&#44; o alelo A de IL&#8208;17A &#40;rs2275913&#41; foi encontrado apenas em 1&#44;8&#37;&#8208;21&#44;1&#37; em povos africanos&#46; De acordo com os dados da SNPedia&#44; descobriu&#8208;se que o alelo A de IL&#8208;17A &#40;rs2275913&#41; era inferior ao alelo G &#40;29&#44;2&#37; e 70&#44;8&#37;&#44; respectivamente&#41;&#44; e o gen&#243;tipo AA era o gen&#243;tipo mais baixo &#40;10&#47;60&#44; 16&#44;7&#37;&#41; no grupo de pacientes com hansen&#237;ase&#46; Recentemente&#44; Mazurek&#8208;Mochol et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">21</span></a> relataram que o alelo A estava associado a um aumento na produ&#231;&#227;o de IL&#8208;17&#46; Portanto&#44; a diminui&#231;&#227;o do alelo A de IL&#8208;17A &#40;rs2275913&#41; e do gen&#243;tipo AA nos casos estudados do presente estudo tamb&#233;m poderia explicar essa diferen&#231;a&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclus&#245;es</span><p id="par0200" class="elsevierStylePara elsevierViewall">A IL&#8208;17A pode ter papel ativo na patog&#234;nese da hansen&#237;ase&#46; Embora os polimorfismos de IL&#8208;17A &#40;rs2275913A&#47;G&#41; tenham papel n&#227;o significativo na suscetibilidade gen&#233;tica ao desenvolvimento da hansen&#237;ase&#44; o gen&#243;tipo GG de IL&#8208;17A &#40;rs2275913A&#47;G&#41;&#44; bem como o alelo G&#44; mostraram ter valor significativo e tamb&#233;m foi comprovada sua liga&#231;&#227;o com a progress&#227;o para HV na popula&#231;&#227;o eg&#237;pcia&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Suporte financeiro</span><p id="par0205" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Contribui&#231;&#227;o dos autores</span><p id="par0210" class="elsevierStylePara elsevierViewall">Todos os autores fizeram contribui&#231;&#245;es substanciais para todos os itens a seguir&#58;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Azza Gaber Antar Farag&#58; Revis&#227;o cr&#237;tica da literatura&#59; Concep&#231;&#227;o e planejamento do estudo&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Azza Zagloul labeeb&#58; Obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o de dados&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Amany Nagy Abdalla Gerges&#58; Obten&#231;&#227;o de dados&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Mustafa Elsayed Elshaib&#58; An&#225;lise estat&#237;stica&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Todos os autores aprovaram o artigo final&#46; Os autores confirmam que todos os autores nomeados concordaram com a submiss&#227;o do manuscrito e participaram do estudo o suficiente para serem nomeados como autores&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Os autores confirmam que n&#227;o h&#225; conflito de interesses&#44; e o presente estudo tem o n&#250;mero de aprova&#231;&#227;o do Comit&#234; de &#201;tica &#40;1202&#47;2&#47;4&#47;2019&#41;&#44; fornecido pelo Comit&#234; de Direitos Humanos em Pesquisa&#44; Menoufia University&#44; que est&#227;o de acordo com a Declara&#231;&#227;o de Helsinque de 1975 &#40;revisada em 2000&#41;&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflito de interesses</span><p id="par0250" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A hansen&#237;ase representa uma doen&#231;a transmiss&#237;vel de longa dura&#231;&#227;o&#44; resultante de infec&#231;&#227;o por <span class="elsevierStyleItalic">Mycobacterium leprae</span>&#46; A interleucina&#8208;17A &#40;IL&#8208;17A&#41; &#233; uma das citocinas pr&#243;&#8208;inflamat&#243;rias que protege o ser humano contra muitos pat&#243;genos f&#250;ngicos e bacterianos&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Investigar o polimorfismo do gene IL&#8208;17A &#40;rs2275913&#41; e seu n&#237;vel circulante em pacientes com hansen&#237;ase e correlacionar os resultados detectados com diferentes aspectos cl&#237;nicos da hansen&#237;ase nos pacientes investigados&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Sessenta pacientes com hansen&#237;ase e 29 volunt&#225;rios pareados por idade e sexo foram investigados em rela&#231;&#227;o ao n&#237;vel s&#233;rico de IL&#8208;17A e o polimorfismo de nucleot&#237;deo &#250;nico &#40;PNU&#41; de IL&#8208;17A por ELISA e RFLP&#8208;PCR&#44; respectivamente&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">O n&#237;vel s&#233;rico de IL&#8208;17A foi significativamente maior em pacientes com hansen&#237;ase do que nos controles &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;034&#41;&#44; e em HT do que em HV &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;017&#41;&#46; O alelo G de IL&#8208;17A &#40;rs2275913 A&#47;G&#41; e o gen&#243;tipo GG foram significativamente associados a HV &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005 e 0&#44;001&#44; respectivamente&#41;&#46; Os portadores do gen&#243;tipo AG de IL&#8208;17A &#40;rs2275913 A&#47;G&#41; demonstraram os n&#237;veis s&#233;ricos mais elevados de IL&#8208;17A&#59; entretanto&#44; os n&#237;veis mais baixos foram encontrados em portadores do gen&#243;tipo AA de IL&#8208;17A &#40;rs2275913 A&#47;G&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#46; O grau de defici&#234;ncia 2 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;030&#41; e a baciloscopia &#40;SSS&#44; <span class="elsevierStyleItalic">slit skin smear</span>&#41; positiva &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41; foram significativamente associados ao gen&#243;tipo GG de IL&#8208;17A &#40;rs2275913 A&#47;G&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">O pequeno n&#250;mero de indiv&#237;duos estudados&#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 IL&#8208;17A pode ter um papel fundamental na patog&#234;nese da hansen&#237;ase&#46; O gen&#243;tipo GG da IL&#8208;17A &#40;rs2275913&#41; mais a presen&#231;a do alelo G podem explicar o desenvolvimento de HV na popula&#231;&#227;o eg&#237;pcia&#46;</p></span>"
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          "pt" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Imagens de eletroforese em gel de agarose para os gen&#243;tipos da IL&#8208;17A&#44; gen&#243;tipo GG&#44; bandas 3&#44; 4&#44; 5&#44; 6&#44; 7 e 9&#59; gen&#243;tipo AG&#44; bandas 2&#44; 10 e 11&#59; gen&#243;tipo AA&#44; bandas 1 e 8&#46;</p>"
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                  \t\t\t\t">51&#44;97<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;67&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">45&#44;92<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Teste <span class="elsevierStyleItalic">U</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;056&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Mediana&nbsp;\t\t\t\t\t\t\n
                  \t\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">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&nbsp;\t\t\t\t\t\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
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Varia&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">19&#8211;82&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16&#8211;78&nbsp;\t\t\t\t\t\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
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Sexo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#967;<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Masculino&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">44 &#40;73&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">23 &#40;79&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;38&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;540&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">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">16 &#40;26&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;20&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resid&#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="" 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="" 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="" 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="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rural&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;83&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;75&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;401&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">Urbana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;16&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;24&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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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="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ocupa&#231;&#227;o&nbsp;\t\t\t\t\t\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
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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="" 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="" 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="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Trabalhando&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47 &#40;78&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;62&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;105&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">N&#227;o trabalhando<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;21&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;37&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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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="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#237;vel socioecon&#244;mico&nbsp;\t\t\t\t\t\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
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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="" 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="" 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></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">Alto&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">1 &#40;1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;27&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#44;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&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">M&#233;dio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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 &#40;8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;37&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Baixo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54 &#40;90&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;34&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hist&#243;ria familiar de hansen&#237;ase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positiva&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;13&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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">4&#44;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;039<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&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">Negativa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52 &#40;86&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;100&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tipo de hansen&#237;ase&nbsp;\t\t\t\t\t\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
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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="" 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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&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">HB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;33&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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
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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="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;41&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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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="" 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
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Grau de defici&#234;ncia&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\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Grau 0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15 &#40;41&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\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">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&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">Grau 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">10 &#40;16&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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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="" 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="" 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 ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Grau 2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">25 &#40;41&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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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">Baciloscopia&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">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\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">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\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">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Positiva&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">35 &#40;58&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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="" 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></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Negativa&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">25 &#40;41&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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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\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Dura&#231;&#227;o da doen&#231;a &#40;anos&#41;&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 ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">M&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;10<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\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">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Mediana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><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">Varia&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#8211;25 meses&nbsp;\t\t\t\t\t\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
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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="" 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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            0 => array:3 [
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          "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Dados sociodemogr&#225;ficos e cl&#237;nicos dos indiv&#237;duos estudados</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">DP&#44; desvio padr&#227;o&#59; pg&#47;mL&#44; picograma por mililitro&#59; &#967;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">2</span></a>&#44; teste de Qui&#8208;quadrado&#59; U&#44; teste de Mann&#8208;Whitney&#46;</p>"
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IL&#8208;17A&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">M&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">M&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;57&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;42<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;77&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Mediana&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Varia&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;74&#8211;3&#44;94&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;41&#8211;3&#44;64&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Teste de Kruskal&#8208;Wallis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">10&#44;69&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">p&#8208;valor&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;505&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "pt" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Rela&#231;&#227;o entre os n&#237;veis s&#233;ricos de IL&#8208;17A e gen&#243;tipos de IL&#8208;17A &#40;rs2275913&#41; em pacientes com hansen&#237;ase e grupo controle</p>"
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                    0 => array:2 [
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                    0 => array:2 [
                      "doi" => "10.1016/j.cyto.2013.03.014"
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                          "etal" => false
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                            0 => "C&#46; Zenobia"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Periodontology"
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                      "titulo" => "Updating indicators for scaling the socioeconomic level of families for health research"
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;L&#46; Fahmy"
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                            3 => "H&#46;M&#46; El Kady"
                            4 => "H&#46;K&#46; Ibrahim"
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Egypt Public Health Assoc&#46;"
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                            2 => "P&#46;L&#46;S&#46; Almeida"
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                            5 => "R&#46;A&#46; Cazzaniga"
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Artigo original
Interleucina‐17A em pacientes egípcios com hanseníase: estudo clínico, genético e bioquímico
Azza Gaber Antar Faraga,
Autor para correspondência
azzagaber92@yahoo.com

Autor para correspondência.
, Azza Zagloul Labeebb, Amany Nagy Abdalla Gergesc, Mustafa Elsayed Elshaibd
a Departamento de Dermatologia, Andrologia e ISTs, Faculdade de Medicina, Menoufia University, Egito
b Departamento de Microbiologia e Imunologia, Faculdade de Medicina, Menoufia University, Egito
c Clínica de Hanseníase e Dermatologia, Ministério da Saúde, Shebin Elkoom Teaching Hospital, Egito
d Acadêmico de Medicina, Faculdade de Medicina, Menoufia University, Egito
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que ainda &#233; um dos 22 pa&#237;ses de prioridade global&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A hansen&#237;ase &#233; classificada em dois tipos polares&#58; hansen&#237;ase tuberculoide &#40;HT&#41; e hansen&#237;ase virchowiana &#40;HV&#41;&#44; mais tr&#234;s tipos intermedi&#225;rios&#59; borderline tuberculoide &#40;BT&#41;&#44; borderline borderline &#40;BB&#41; e borderline virchowiana &#40;BV&#41;&#46; A HT &#233; caracterizada pela presen&#231;a de poucos bacilos &#40;paucibacilar &#8208; PB&#41; e imunidade mediada por c&#233;lulas eficiente&#46; No entanto&#44; a HV &#233; caracterizada por numerosos bacilos &#40;multibacilar &#8208; MB&#41; e imunidade mediada por c&#233;lulas ineficiente&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Na HT&#44; h&#225; alta propor&#231;&#227;o de c&#233;lulas T CD4<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>com aumento de citocinas tipo 1&#46; Por outro lado&#44; a HV mostra predomin&#226;ncia de c&#233;lulas T CD8<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>com citocinas tipo 2&#46; Os dados mencionados demonstram as intera&#231;&#245;es imunopatol&#243;gicas entre as citocinas tipo 2 e tipo 1 e produtos de macr&#243;fagos ativados &#40;monocinas&#41; na hansen&#237;ase&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">No entanto&#44; certo subconjunto de c&#233;lulas T mostrou produzir citocinas que n&#227;o podem ser classificadas de acordo com o esquema Th1&#8208;Th2&#46; A interleucina &#40;IL&#41;&#8208;17 est&#225; entre essas citocinas&#44; e as c&#233;lulas T produtoras de IL&#8208;17 foram denominadas c&#233;lulas Th17&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">A IL&#8208;17A &#233; uma prote&#237;na que em seres humanos &#233; codificada pelo gene IL&#8208;17A&#46; &#201; uma citocina pr&#243;&#8208;inflamat&#243;ria&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">7</span></a> Originalmente&#44; a IL&#8208;17A deveria ser produzida exclusivamente por c&#233;lulas T&#44; mas tamb&#233;m &#233; secretada por muitas outras c&#233;lulas&#44; incluindo c&#233;lulas dendr&#237;ticas &#40;CD&#41;&#44; macr&#243;fagos&#44; c&#233;lulas <span class="elsevierStyleItalic">natural killer</span> &#40;NK&#41; e c&#233;lulas &#947;&#948;&#8208;T&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">A IL&#8208;17A atua em c&#233;lulas estruturais&#44; como c&#233;lulas epiteliais&#44; fibroblastos e queratin&#243;citos em v&#225;rios tecidos&#44; incluindo a pele&#46; Essas c&#233;lulas expressam o receptor de IL&#8208;17 e produzem muitas citocinas necess&#225;rias para a resposta inflamat&#243;ria&#44; como o fator estimulador de col&#244;nias de granul&#243;citos &#40;GCSF&#44; do ingl&#234;s <span class="elsevierStyleItalic">granulocyte colony&#8208;stimulating factor</span>&#41; e IL&#8208;6&#44; bem como quimiocinas para atrair neutr&#243;filos e macr&#243;fagos para os tecidos inflamados&#46; Essas c&#233;lulas inflamat&#243;rias &#40;neutr&#243;filos e macr&#243;fagos&#41; podem tanto eliminar a infec&#231;&#227;o como iniciar um processo patog&#234;nico&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Al&#233;m disso&#44; a liga&#231;&#227;o da IL&#8208;17A ao receptor de IL&#8208;17 causa mudan&#231;as conformacionais importantes que possibilitam a liga&#231;&#227;o de adaptadores de sinaliza&#231;&#227;o&#44; como os fatores associados ao receptor de TNF &#40;TRAFs&#44; do ingl&#234;s <span class="elsevierStyleItalic">TNF&#8208;receptor associated factors</span>&#41;&#46; A liga&#231;&#227;o desses adaptadores de sinaliza&#231;&#227;o desencadeia a ativa&#231;&#227;o de v&#225;rias vias de sinaliza&#231;&#227;o&#44; incluindo o fator nuclear kappa B &#40;NF&#8208;&#954;B&#41; e vias da prote&#237;na&#8208;quinase ativada por mit&#243;geno &#40;MAPK&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">9</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">A ativa&#231;&#227;o dessas vias leva &#224; produ&#231;&#227;o de muitas citocinas inflamat&#243;rias&#44; como IL&#8208;1&#946;&#44; fator de necrose tumoral alfa &#40;TNF&#8208;&#945;&#41; e quimiocinas&#44; que atraem macr&#243;fagos&#44; bem como produtos antimicrobianos como mucinas e defensinas&#46; Por meio de seus efeitos inflamat&#243;rios&#44; esses produtos ajudam na elimina&#231;&#227;o de muitos pat&#243;genos estranhos&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Foi demonstrado que a IL&#8208;17A protege o corpo humano contra v&#225;rias infec&#231;&#245;es bacterianas e f&#250;ngicas causadas por pat&#243;genos invasores&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">9</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">O objetivo do presente estudo foi esclarecer o hipot&#233;tico papel da IL&#8208;17A na patog&#234;nese da hansen&#237;ase&#44; por meio da an&#225;lise do polimorfismo do gene IL&#8208;17A &#40;rs2275913&#41;&#44; al&#233;m de seus n&#237;veis s&#233;ricos em pacientes com hansen&#237;ase&#44; e correlacionar os resultados obtidos com diferentes aspectos cl&#237;nicos da hansen&#237;ase nos pacientes investigados&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Materiais e m&#233;todos</span><p id="par0060" class="elsevierStylePara elsevierViewall">O presente trabalho foi um estudo de caso&#8208;controle&#46; Foi realizado em 60 pacientes com tipos variados de hansen&#237;ase e 29 volunt&#225;rios saud&#225;veis pareados por idade e sexo&#44; sem hist&#243;ria pregressa ou familiar de hansen&#237;ase &#40;grupo controle&#41;&#46; Os pacientes com hansen&#237;ase e o grupo controle foram selecionados no Ambulat&#243;rio de Dermatologia e Hansen&#237;ase&#44; Menoufia Teaching and University Hospitals&#46; A parte laboratorial do estudo foi realizada no Departamento de Microbiologia e Imunologia&#44; Faculdade de Medicina&#44; Menoufia University&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">O estudo foi aprovado pelo Comit&#234; de &#201;tica em Direitos Humanos em Pesquisa&#44; Menoufia University&#46; O termo de consentimento informado por escrito foi assinado por cada participante ap&#243;s a informa&#231;&#227;o sobre o estudo&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Foram inclu&#237;dos pacientes de ambos os sexos com hansen&#237;ase confirmada por meio do aspecto cl&#237;nico das les&#245;es&#44; baciloscopia &#40;SSS&#44; do ingl&#234;s <span class="elsevierStyleItalic">slit skin smear</span>&#41; positiva pr&#233;via e&#47;ou avalia&#231;&#227;o histopatol&#243;gica&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Indiv&#237;duos com qualquer uma das seguintes condi&#231;&#245;es foram exclu&#237;dos deste estudo&#58; 1&#8208; doen&#231;as sist&#234;micas &#40;por exemplo&#44; diabetes <span class="elsevierStyleItalic">mellitus</span>&#44; 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5<span class="elsevierStyleHsp" style=""></span>mL de sangue foram obtidos de cada indiv&#237;duo e divididos em duas partes&#46; A primeira parte &#40;2<span class="elsevierStyleHsp" style=""></span>mL&#41; foi mantida em tubo simples&#44; deixada a 37<span class="elsevierStyleHsp" style=""></span>&#176;C por 30 minutos para coagular&#44; depois centrifugada a 4000<span class="elsevierStyleHsp" style=""></span>rpm por 10 minutos&#46; O soro obtido foi separado em al&#237;quotas e mantido a<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>80<span class="elsevierStyleHsp" style=""></span>&#176;C at&#233; o momento da an&#225;lise para determina&#231;&#227;o do n&#237;vel s&#233;rico de IL&#8208;17A utilizando kits de ELISA &#40;Neo Bio science Technology Co&#46;&#44; Ltd&#44; Shenzhen&#44; China&#41; de acordo com as instru&#231;&#245;es do fabricante&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">A segunda parte &#40;3<span class="elsevierStyleHsp" style=""></span>mL&#41; foi transferida imediatamente para tubo vacutainer com EDTA e armazenada para extra&#231;&#227;o de DNA&#46; A extra&#231;&#227;o de DNA foi feita utilizando o mini kit <span class="elsevierStyleItalic">Gene JET&#8482; Whole Blood Genomic DNA Purification</span> &#40;THERMO SCIENTIFIC&#44; EU&#47;Litu&#226;nia&#41;&#44; seguindo as instru&#231;&#245;es do fabricante&#46; A genotipagem do SNP para IL17A &#8208;197G&#92;A &#40;rs2275913&#41; foi obtida pela an&#225;lise de polimorfismo de fragmentos de restri&#231;&#227;o utilizando a rea&#231;&#227;o em cadeia da polimerase &#40;PCR&#8208;RFLP&#41;&#46; As sequ&#234;ncias de <span class="elsevierStyleItalic">primers</span> para IL17A&#8208;197G&#92;A foram 5&#8217;&#8208;AACAAGTAAGAATGAAAAGAGGACATGGT&#8208;3&#8217;&#40;<span class="elsevierStyleItalic">sense</span>&#41; e 5&#8217;&#8208; CCCCCAATGAGGTCATAGAAGAATC&#8208;3&#8217;&#40;<span class="elsevierStyleItalic">anti&#8208;sense</span>&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">A amplifica&#231;&#227;o de PCR foi realizada em um volume de 30<span class="elsevierStyleHsp" style=""></span>&#956;L de mistura contendo 100 ng de DNA gen&#244;mico&#44; 1&#44;0<span class="elsevierStyleHsp" style=""></span>&#956;M de cada <span class="elsevierStyleItalic">primer</span>&#44; 200<span class="elsevierStyleHsp" style=""></span>&#956;M de cada dNTP&#44; 2&#44;0<span class="elsevierStyleHsp" style=""></span>mM de MgCl<span class="elsevierStyleInf">2</span>&#44; 3<span class="elsevierStyleHsp" style=""></span>&#956;L de tamp&#227;o de PCR 10<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>e 1&#44;5 U Taq DNA polimerase &#40;Invitrogen Life Technologies&#44; Grand Island&#44; NY&#44; EUA&#41;&#46; As enzimas de restri&#231;&#227;o XagI &#40;THERMO SCIENTIFIC&#44; EU&#47;Litu&#226;nia&#41; foram usadas para diferenciar os gen&#243;tipos IL17A&#8208;197G&#92;A &#40;rs2275913&#41; &#8211; 102&#44; 68&#44; 34 pb&#46; O produto de PCR e a enzima foram bem misturados e incubados a 37<span class="elsevierStyleHsp" style=""></span>&#176;C durante 1&#44;5 hora&#46; O padr&#227;o de migra&#231;&#227;o dos produtos da digest&#227;o em gel de agarose a 3&#37; possibilitou a identifica&#231;&#227;o dos gen&#243;tipos IL17A&#8208;197G&#92;A&#46; A genotipagem foi realizada &#224;s cegas e em quantidades iguais de casos e controles&#46; O gen&#243;tipo G &#40;68<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>34 pb&#41;&#44; o gen&#243;tipo A &#40;102 pb&#41; e o AG &#40;102&#44; 68&#44; 34 pb&#41; foram identificados&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">13</span></a></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">An&#225;lise estat&#237;stica</span><p id="par0105" class="elsevierStylePara elsevierViewall">Os dados coletados foram analisados estatisticamente pelo <span class="elsevierStyleItalic">software</span> SPSS &#40;vers&#227;o 20&#41; em computador compat&#237;vel com IBM&#46; Duas formas de an&#225;lise estat&#237;stica foram realizadas&#58; 1&#41; estat&#237;stica descritiva&#58; foram expressas como m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desvio padr&#227;o &#40;X<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&#41; bem como mediana e intervalo para dados quantitativos ou n&#250;mero e porcentagem &#40;N<span class="elsevierStyleSup">o</span> e &#37;&#41; para dados qualitativos&#59; 2&#41; estat&#237;stica anal&#237;tica&#58; foram utilizados os testes Qui&#8208;Quadrado &#40;&#967;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">2</span></a>&#41;&#44; Mann&#8208;Whitney&#44; Kruskal&#8208;Wallis e Z&#59; p &#8804; 0&#44;05 foi considerado estatisticamente significativo&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Resultados</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Dados sociodemogr&#225;ficos e cl&#237;nicos</span><p id="par0110" class="elsevierStylePara elsevierViewall">A idade dos casos selecionados variou de 19 a 82 anos&#44; dos quais 44 &#40;73&#44;3&#37;&#41; eram homens e 16 &#40;26&#44;7&#37;&#41; mulheres&#44; e 83&#37; dos pacientes estudados eram da zona rural&#46; Quinze &#40;25&#37;&#41; pacientes com hansen&#237;ase tinham HT&#44; 25 &#40;41&#44;7&#37;&#41; pacientes tinham HV e 20 &#40;33&#44;3&#37;&#41; casos tinham BV&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Em compara&#231;&#227;o aos controles&#44; a maioria dos pacientes com hansen&#237;ase &#40;90&#37;&#41; tinha NSE significativamente baixo &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e 13&#44;3&#37; deles tinham hist&#243;ria familiar positiva de hansen&#237;ase &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;039&#59; <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">N&#237;veis s&#233;ricos de IL&#8208;17A</span><p id="par0120" class="elsevierStylePara elsevierViewall">N&#237;veis s&#233;ricos de IL&#8208;17A significativamente mais altos foram observados nos pacientes com hansen&#237;ase &#40;4&#44;84<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;79&#41; do que no grupo controle &#40;2&#44;04<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;25&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;034&#59; <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#44; que foram significativamente maiores no grupo HT &#40;4&#44;52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;87&#41; do que no grupo HV &#40;2&#44;91<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;69&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;017&#59; <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Rela&#231;&#227;o entre os n&#237;veis s&#233;ricos de IL&#8208;17A e dados cl&#237;nicos em pacientes com hansen&#237;ase</span><p id="par0125" class="elsevierStylePara elsevierViewall">Os n&#237;veis s&#233;ricos de IL&#8208;17A n&#227;o foram afetados por quaisquer dados pessoais ou cl&#237;nicos nos casos de hansen&#237;ase estudados&#44; exceto pelo sexo&#44; pois n&#237;veis s&#233;ricos de IL&#8208;17A significativamente mais elevados foram relatados em pacientes com hansen&#237;ase do sexo feminino do que no sexo masculino &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;007&#59; <a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Gen&#243;tipos e alelos de IL&#8208;17 &#40;rs2275913A&#47;G&#41;</span><p id="par0130" class="elsevierStylePara elsevierViewall">O estudo do SNP de IL&#8208;17A &#40;rs2275913A&#47;G&#59; <a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41; mostrou que havia diferen&#231;a estatisticamente n&#227;o significativa entre pacientes com hansen&#237;ase e grupo controle em rela&#231;&#227;o aos gen&#243;tipos de IL&#8208;17A &#40;rs2275913A&#47;G&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;898&#41; e distribui&#231;&#227;o de alelos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;625&#59; <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46; Entretanto&#44; foram demonstradas diferen&#231;as significativas entre os pacientes com os tr&#234;s tipos de hansen&#237;ase em rela&#231;&#227;o &#224;s distribui&#231;&#245;es percentuais dos gen&#243;tipos de IL&#8208;17A &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e os alelos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#44; uma vez que o gen&#243;tipo GG do IL&#8208;17A &#40;rs2275913A&#47;G&#41; al&#233;m do alelo G foram associados significativamente com HV&#44; enquanto o gen&#243;tipo AG estava significativamente associado a casos de HT &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Rela&#231;&#227;o entre gen&#243;tipos de IL&#8208;17A e dados cl&#237;nicos em pacientes com hansen&#237;ase</span><p id="par0135" class="elsevierStylePara elsevierViewall">Diferen&#231;as n&#227;o significativas foram encontradas entre os gen&#243;tipos de IL&#8208;17A &#40;rs2275913A&#47;G&#41; em rela&#231;&#227;o aos dados pessoais e cl&#237;nicos de pacientes com hansen&#237;ase&#44; exceto grau de incapacidade e SSS&#44; pois uma porcentagem maior de incapacidade de grau 2 e SSS positiva foram associadas significativamente com o gen&#243;tipo GG de IL&#8208;17A &#40;rs2275913A&#47;G&#41; quando comparadas aos gen&#243;tipos AG e GG &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;030 e 0&#44;005&#59; respectivamente&#59; <a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Rela&#231;&#227;o entre os n&#237;veis s&#233;ricos de IL&#8208;17A e gen&#243;tipos de IL&#8208;17A &#40;rs2275913A&#47;G&#41;</span><p id="par0140" class="elsevierStylePara elsevierViewall">Em pacientes com hansen&#237;ase&#44; havia rela&#231;&#227;o estatisticamente significativa entre os gen&#243;tipos de IL&#8208;17A &#40;rs2275913A&#47;G&#41; e os n&#237;veis s&#233;ricos de IL&#8208;17A&#44; pois os n&#237;veis mais altos foram encontrados em portadores do gen&#243;tipo AG de IL&#8208;17A &#40;rs2275913A&#47;G&#41; e os n&#237;veis mais baixos foram encontrados em portadores do gen&#243;tipo AA &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#46; Entretanto&#44; no grupo controle&#44; foi encontrada rela&#231;&#227;o n&#227;o significante &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;505&#59; <a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discuss&#227;o</span><p id="par0145" class="elsevierStylePara elsevierViewall">Em v&#225;rias condi&#231;&#245;es patog&#234;nicas&#44; a IL&#8208;17A pode eliminar a infec&#231;&#227;o e iniciar a rea&#231;&#227;o inflamat&#243;ria que pode ser mediada pela via NF&#8208;&#954;B&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">9</span></a> via produ&#231;&#227;o de muitas citocinas inflamat&#243;rias como TNF&#8208;&#945;&#44; IL&#8208;1&#946;&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">10</span></a> G&#8208;CSF e IL&#8208;6&#44; bem como quimiotaxia de macr&#243;fagos e neutr&#243;filos para os tecidos inflamados&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">De acordo com esses dados&#44; foi demonstrado que os n&#237;veis circulantes de IL&#8208;17A apresentaram valores m&#233;dios significativamente mais altos em pacientes com hansen&#237;ase do que os controles e em HT do que em HV&#46; Esse n&#237;vel alto pode representar o mecanismo de defesa do organismo contra a infec&#231;&#227;o pelo bacilo da hansen&#237;ase&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Em concord&#226;ncia com o resultado do presente estudo&#44; Sakdiah et al&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">14</span></a> estudaram 40 pacientes indon&#233;sios com hansen&#237;ase <span class="elsevierStyleItalic">versus</span> 40 controles&#46; Eles demonstraram que os n&#237;veis s&#233;ricos de IL&#8208;17 em pacientes com hansen&#237;ase eram maiores do que nos controles&#46; Al&#233;m disso&#44; Santos et al&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a> investigaram 51 pacientes brasileiros com hansen&#237;ase e 23 controles&#46; Os autores revelaram que as concentra&#231;&#245;es de IL&#8208;17A eram mais elevadas em pacientes com HT do que HV e controles&#46; Al&#233;m disso&#44; eles demonstraram mais c&#233;lulas CD4<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#47;IL&#8208;17A<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>em les&#245;es de pele de pacientes com HT do que em pacientes com HV&#46; Santos et al&#46; relataram uma associa&#231;&#227;o significativa entre as c&#233;lulas Th17 e uma resposta inflamat&#243;ria efetiva nas formas PB&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">No presente estudo&#44; foi demonstrado um n&#237;vel s&#233;rico significativamente mais alto de IL&#8208;17A em pacientes do sexo feminino do que no sexo masculino&#46; Tsuboi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a> estudaram 409 pacientes &#40;200 homens&#44; 208 mulheres&#41; no Jap&#227;o e encontraram n&#237;veis s&#233;ricos elevados de IL&#8208;17A em mulheres com depress&#227;o&#46; Portanto&#44; pode&#8208;se especular que o aumento dos n&#237;veis s&#233;ricos de IL&#8208;17A em pacientes do sexo feminino pode ser explicado pelo fato de essas mulheres estarem sofrendo de altera&#231;&#245;es psiqui&#225;tricas&#44; incluindo depress&#227;o resultante de seu estado de adoecimento&#46; Al&#233;m disso&#44; as mulheres s&#227;o mais suscet&#237;veis a desenvolver mais altera&#231;&#245;es inflamat&#243;rias e autoimunes do que os homens&#44; e o aumento dos n&#237;veis s&#233;ricos de IL&#8208;17 pode sinalizar para isso antes mesmo do aparecimento do quadro cl&#237;nico&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Embora <span class="elsevierStyleItalic">M&#46; leprae</span> possa infectar muitas pessoas&#44; poucas adoecem&#44; o que pode ser atribu&#237;do&#44; em parte&#44; &#224; influ&#234;ncia da heran&#231;a gen&#233;tica na resposta imune&#46; Acredita&#8208;se que muitos SNPs est&#227;o ligados &#224; produ&#231;&#227;o de citocinas e quimiocinas que foram implicadas nas formas cl&#237;nicas de hansen&#237;ase e epis&#243;dios reacionais&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">17&#44;18</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">O presente estudo mostrou diferen&#231;a estatisticamente n&#227;o significativa entre pacientes com hansen&#237;ase e grupo controle quanto aos gen&#243;tipos de IL&#8208;17 &#40;rs2275913A&#47;G&#41; e distribui&#231;&#227;o de alelos&#46; No entanto&#44; a compara&#231;&#227;o entre os subgrupos de hansen&#237;ase &#40;HV&#44; HT e BV&#41; revelou que o gen&#243;tipo IL&#8208;17 &#40;rs2275913A&#47;G&#41; GG&#44; al&#233;m do alelo G&#44; estavam associados significativamente com HV&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Em concord&#226;ncia com os resultados do presente estudo&#44; Aquino et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">19</span></a> estudaram 150 pacientes brasileiros com hansen&#237;ase e 150 contatos domiciliares&#46; Eles descobriram que as frequ&#234;ncias genot&#237;picas apresentavam diferen&#231;as n&#227;o significativas nos pacientes com hansen&#237;ase em geral e os controles&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">19</span></a> Al&#233;m disso&#44; Escamilla&#8208;Tilch et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">20</span></a> investigaram 75 pacientes mexicanos mesti&#231;os com hansen&#237;ase <span class="elsevierStyleItalic">versus</span> 69 controles&#46; Sessenta e dois pacientes foram classificados como HV&#44; dois como HT&#44; dois como BV e nove como borderline&#46; Eles n&#227;o encontraram associa&#231;&#227;o entre os SNPs do gene IL&#8208;17A &#40;rs2275913A&#47;G&#41; e hansen&#237;ase&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">20</span></a> Portanto&#44; o presente estudo confirmou a evid&#234;ncia de falta de rela&#231;&#227;o entre o polimorfismo do gene IL&#8208;17A &#40;rs2275913A&#47;G&#41; e a suscetibilidade &#224; hansen&#237;ase&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Em rela&#231;&#227;o aos subgrupos de hansen&#237;ase&#44; embora tenha sido relatada uma associa&#231;&#227;o significativa entre o alelo G de IL&#8208;17A &#40;rs2275913A&#47;G&#41; e o gen&#243;tipo GG com HV&#44; Escamilla&#8208;Tilch et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">20</span></a> n&#227;o encontraram essa associa&#231;&#227;o&#46; Essa diferen&#231;a pode ser explicada com base em fatores ambientais e socioecon&#244;micos que podem influenciar o desenvolvimento de diferentes doen&#231;as&#46; Al&#233;m disso&#44; Escamilla&#8208;Tilch et al&#46; investigaram apenas quatro casos &#40;dois como HT e dois como BV&#41; <span class="elsevierStyleItalic">versus</span> 62 com HV&#44; e esse tamanho de amostra pode n&#227;o ser adequado para avalia&#231;&#227;o estat&#237;stica&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">20</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">No presente estudo&#44; observou&#8208;se que maior porcentagem de incapacidade grau 2 e baciloscopia positiva estavam significativamente associadas ao gen&#243;tipo GG de IL&#8208;17A &#40;rs2275913A&#47;G&#41;&#44; confirmando que o estudo atual demonstrou maior predomin&#226;ncia do gen&#243;tipo GG nos pacientes com HV&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Entre os gen&#243;tipos de IL&#8208;17 &#40;rs2275913A&#47;G&#41; estudados&#44; os portadores do gen&#243;tipo AG demonstraram os n&#237;veis s&#233;ricos mais elevados de IL&#8208;17&#46; Isso pode ser esclarecido pela predomin&#226;ncia do gen&#243;tipo AG nos casos de HT estudados no presente estudo&#44; que &#233; caracterizado por boa imunidade e alta resposta imune mediada por c&#233;lulas&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Entretanto&#44; Aquino et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">19</span></a> mostraram que o gen&#243;tipo AA de IL&#8208;17A &#40;rs2275913&#41; estava relacionado a n&#237;veis s&#233;ricos elevados de IL&#8208;17A&#46; Essa diferen&#231;a pode ser atribu&#237;da a fatores &#233;tnicos&#47;raciais e gen&#233;ticos&#46; Aquino et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">19</span></a> estudaram uma popula&#231;&#227;o parda do sul do Brasil&#59; por&#233;m o presente estudo investigou a popula&#231;&#227;o eg&#237;pcia&#44; que pertence &#224; ra&#231;a africana&#46; De acordo com a SNPedia para IL&#8208;17A &#40;rs2275913&#41;&#44; o alelo A de IL&#8208;17A &#40;rs2275913&#41; foi encontrado apenas em 1&#44;8&#37;&#8208;21&#44;1&#37; em povos africanos&#46; De acordo com os dados da SNPedia&#44; descobriu&#8208;se que o alelo A de IL&#8208;17A &#40;rs2275913&#41; era inferior ao alelo G &#40;29&#44;2&#37; e 70&#44;8&#37;&#44; respectivamente&#41;&#44; e o gen&#243;tipo AA era o gen&#243;tipo mais baixo &#40;10&#47;60&#44; 16&#44;7&#37;&#41; no grupo de pacientes com hansen&#237;ase&#46; Recentemente&#44; Mazurek&#8208;Mochol et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">21</span></a> relataram que o alelo A estava associado a um aumento na produ&#231;&#227;o de IL&#8208;17&#46; Portanto&#44; a diminui&#231;&#227;o do alelo A de IL&#8208;17A &#40;rs2275913&#41; e do gen&#243;tipo AA nos casos estudados do presente estudo tamb&#233;m poderia explicar essa diferen&#231;a&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclus&#245;es</span><p id="par0200" class="elsevierStylePara elsevierViewall">A IL&#8208;17A pode ter papel ativo na patog&#234;nese da hansen&#237;ase&#46; Embora os polimorfismos de IL&#8208;17A &#40;rs2275913A&#47;G&#41; tenham papel n&#227;o significativo na suscetibilidade gen&#233;tica ao desenvolvimento da hansen&#237;ase&#44; o gen&#243;tipo GG de IL&#8208;17A &#40;rs2275913A&#47;G&#41;&#44; bem como o alelo G&#44; mostraram ter valor significativo e tamb&#233;m foi comprovada sua liga&#231;&#227;o com a progress&#227;o para HV na popula&#231;&#227;o eg&#237;pcia&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Suporte financeiro</span><p id="par0205" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Contribui&#231;&#227;o dos autores</span><p id="par0210" class="elsevierStylePara elsevierViewall">Todos os autores fizeram contribui&#231;&#245;es substanciais para todos os itens a seguir&#58;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Azza Gaber Antar Farag&#58; Revis&#227;o cr&#237;tica da literatura&#59; Concep&#231;&#227;o e planejamento do estudo&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Azza Zagloul labeeb&#58; Obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o de dados&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Amany Nagy Abdalla Gerges&#58; Obten&#231;&#227;o de dados&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Mustafa Elsayed Elshaib&#58; An&#225;lise estat&#237;stica&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Todos os autores aprovaram o artigo final&#46; Os autores confirmam que todos os autores nomeados concordaram com a submiss&#227;o do manuscrito e participaram do estudo o suficiente para serem nomeados como autores&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Os autores confirmam que n&#227;o h&#225; conflito de interesses&#44; e o presente estudo tem o n&#250;mero de aprova&#231;&#227;o do Comit&#234; de &#201;tica &#40;1202&#47;2&#47;4&#47;2019&#41;&#44; fornecido pelo Comit&#234; de Direitos Humanos em Pesquisa&#44; Menoufia University&#44; que est&#227;o de acordo com a Declara&#231;&#227;o de Helsinque de 1975 &#40;revisada em 2000&#41;&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflito de interesses</span><p id="par0250" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A hansen&#237;ase representa uma doen&#231;a transmiss&#237;vel de longa dura&#231;&#227;o&#44; resultante de infec&#231;&#227;o por <span class="elsevierStyleItalic">Mycobacterium leprae</span>&#46; A interleucina&#8208;17A &#40;IL&#8208;17A&#41; &#233; uma das citocinas pr&#243;&#8208;inflamat&#243;rias que protege o ser humano contra muitos pat&#243;genos f&#250;ngicos e bacterianos&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Investigar o polimorfismo do gene IL&#8208;17A &#40;rs2275913&#41; e seu n&#237;vel circulante em pacientes com hansen&#237;ase e correlacionar os resultados detectados com diferentes aspectos cl&#237;nicos da hansen&#237;ase nos pacientes investigados&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Sessenta pacientes com hansen&#237;ase e 29 volunt&#225;rios pareados por idade e sexo foram investigados em rela&#231;&#227;o ao n&#237;vel s&#233;rico de IL&#8208;17A e o polimorfismo de nucleot&#237;deo &#250;nico &#40;PNU&#41; de IL&#8208;17A por ELISA e RFLP&#8208;PCR&#44; respectivamente&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">O n&#237;vel s&#233;rico de IL&#8208;17A foi significativamente maior em pacientes com hansen&#237;ase do que nos controles &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;034&#41;&#44; e em HT do que em HV &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;017&#41;&#46; O alelo G de IL&#8208;17A &#40;rs2275913 A&#47;G&#41; e o gen&#243;tipo GG foram significativamente associados a HV &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005 e 0&#44;001&#44; respectivamente&#41;&#46; Os portadores do gen&#243;tipo AG de IL&#8208;17A &#40;rs2275913 A&#47;G&#41; demonstraram os n&#237;veis s&#233;ricos mais elevados de IL&#8208;17A&#59; entretanto&#44; os n&#237;veis mais baixos foram encontrados em portadores do gen&#243;tipo AA de IL&#8208;17A &#40;rs2275913 A&#47;G&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#46; O grau de defici&#234;ncia 2 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;030&#41; e a baciloscopia &#40;SSS&#44; <span class="elsevierStyleItalic">slit skin smear</span>&#41; positiva &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41; foram significativamente associados ao gen&#243;tipo GG de IL&#8208;17A &#40;rs2275913 A&#47;G&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">O pequeno n&#250;mero de indiv&#237;duos estudados&#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 IL&#8208;17A pode ter um papel fundamental na patog&#234;nese da hansen&#237;ase&#46; O gen&#243;tipo GG da IL&#8208;17A &#40;rs2275913&#41; mais a presen&#231;a do alelo G podem explicar o desenvolvimento de HV na popula&#231;&#227;o eg&#237;pcia&#46;</p></span>"
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                  \t\t\t\t">M&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#44;97<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;67&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">45&#44;92<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Teste <span class="elsevierStyleItalic">U</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;056&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">Mediana&nbsp;\t\t\t\t\t\t\n
                  \t\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">52&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">51&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></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">Varia&#231;&#227;o&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">19&#8211;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#8211;78&nbsp;\t\t\t\t\t\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
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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="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sexo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n &#40;&#37;&#41;&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">n &#40;&#37;&#41;&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">&#967;<span class="elsevierStyleSup">2</span>&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></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">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
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                  \t\t\t\t">44 &#40;73&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">23 &#40;79&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;38&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;540&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">Feminino&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">16 &#40;26&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;20&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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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">Resid&#234;ncia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rural&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">50 &#40;83&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">22 &#40;75&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;401&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">Urbana&nbsp;\t\t\t\t\t\t\n
                  \t\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">10 &#40;16&#44;7&#41;&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">7 &#40;24&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><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">Ocupa&#231;&#227;o&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</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">Trabalhando&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">47 &#40;78&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18 &#40;62&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;63&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;105&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">N&#227;o trabalhando<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13 &#40;21&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;37&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><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">N&#237;vel socioecon&#244;mico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;27&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">30&#44;89&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">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&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">M&#233;dio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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 &#40;8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;37&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Baixo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54 &#40;90&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;34&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hist&#243;ria familiar de hansen&#237;ase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positiva&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;13&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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">4&#44;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;039<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&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">Negativa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52 &#40;86&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;100&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tipo de hansen&#237;ase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&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">HB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;33&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;41&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grau de defici&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grau 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">15 &#40;41&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&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">Grau 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">10 &#40;16&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grau 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">25 &#40;41&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Baciloscopia&nbsp;\t\t\t\t\t\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">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&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">Positiva&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;58&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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
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                  \t\t\t\t">Varia&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#8211;25 meses&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">IL&#8208;17A &#40;rs2275913&#41; SNP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Mediana&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">M&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#44;08<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;76&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Mediana&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">3&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;59&#8211;25&#44;60&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;64&#8211;3&#44;54&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">AA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">M&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;57&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;42<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;77&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">Mediana&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;52&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;74&#8211;3&#44;94&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">Teste de Kruskal&#8208;Wallis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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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">p&#8208;valor&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;005<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;505&nbsp;\t\t\t\t\t\t\n
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                0 => "xTab3688202.png"
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Rela&#231;&#227;o entre os n&#237;veis s&#233;ricos de IL&#8208;17A e gen&#243;tipos de IL&#8208;17A &#40;rs2275913&#41; em pacientes com hansen&#237;ase e grupo controle</p>"
        ]
      ]
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    "bibliografia" => array:2 [
      "titulo" => "Refer&#234;ncias"
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        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:21 [
            0 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Two Cases of Leprosy in Siblings Caused by Mycobacterium lepromatosis and Review of the Literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;C&#46; Sotiriou"
                            1 => "B&#46;M&#46; Stryjewska"
                            2 => "C&#46; Hill"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4269/ajtmh.16-0076"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Trop Med Hyg&#46;"
                        "fecha" => "2016"
                        "volumen" => "95"
                        "paginaInicial" => "522"
                        "paginaFinal" => "527"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27402522"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0115"
              "etiqueta" => "2"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Leprosy&#44; a neglected disease that causes a wide variety of clinical conditions in tropical countries"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "N&#46;T&#46; Foss"
                            1 => "A&#46;C&#46; Motta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/s0074-02762012000900006"
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                        "tituloSerie" => "Mem Inst Oswaldo Cruz&#46;"
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