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O omalizumabe &#233; o &#250;nico agente biol&#243;gico aprovado para pacientes com UCE que permanecem sintom&#225;ticos apesar da dose alta de anti&#8208;histam&#237;nico H1&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#8211;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A imprevisibilidade do surgimento de p&#225;pulas urticariformes ou angioedema e a natureza avassaladora da coceira podem levar ao estresse persistente e &#224; redu&#231;&#227;o da qualidade de vida&#46; Estudos relataram associa&#231;&#227;o entre estresse&#44; ansiedade&#44; depress&#227;o e UCE&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#8211;7</span></a> &#201; importante avaliar esses fatores com ferramentas validadas&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Desde que a Organiza&#231;&#227;o Mundial da Sa&#250;de declarou a doen&#231;a do coronav&#237;rus 2019 &#40;COVID&#8208;19&#41; emerg&#234;ncia de sa&#250;de p&#250;blica de interesse internacional&#44; uma pandemia&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> diversas consequ&#234;ncias cl&#237;nicas entraram em cena&#46; Essa doen&#231;a infecciosa imprevis&#237;vel e de r&#225;pida dissemina&#231;&#227;o vem causando preocupa&#231;&#227;o universal&#44; mas tamb&#233;m ansiedade e ang&#250;stia&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> Como estudos anteriores elucidaram que o bem&#8208;estar mental havia sido afetado durante os surtos da doen&#231;a&#44; &#233; esperado que os resultados psicossom&#225;ticos adversos aumentem&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#8211;12</span></a> O aspecto psicol&#243;gico da COVID&#8208;19 em termos de medo&#44; estresse&#44; ansiedade e depress&#227;o ainda n&#227;o foi completamente esclarecido&#44; especialmente em pacientes com doen&#231;as cr&#244;nicas&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Ap&#243;s a detec&#231;&#227;o do primeiro caso de COVID&#8208;19 na Turquia em 9 de mar&#231;o de 2020&#44; v&#225;rias medidas de conten&#231;&#227;o&#44; como distanciamento social&#44; restri&#231;&#245;es de viagem e fechamento de escolas e locais de trabalho&#44; foram implementadas&#46; Esse &#8220;per&#237;odo de quarentena &#40;PQ&#41;&#8221; durou tr&#234;s meses&#46; &#192; medida que o n&#250;mero de casos diminuiu at&#233; o final de maio de 2020&#44; as restri&#231;&#245;es diminu&#237;ram gradualmente em um esfor&#231;o para manter a rotina di&#225;ria&#46; Esse &#8220;retorno ao per&#237;odo normal &#40;RTPN&#41;&#8221; durou tr&#234;s meses&#44; at&#233; o final de agosto de 2020&#46; Os comportamentos dos pacientes com doen&#231;as cr&#244;nicas foram fortemente afetados durante a pandemia&#44; considerando sua ades&#227;o aos medicamentos e comparecimento &#224;s consultas de seguimento&#59; entretanto&#44; n&#227;o h&#225; dados documentados demonstrando as consequ&#234;ncias das restri&#231;&#245;es no comportamento de pacientes com doen&#231;as cr&#244;nicas&#46; Tamb&#233;m se pode esperar que os pacientes com UCE sejam afetados de maneira semelhante pela pandemia&#44; e &#233; importante conhecer a influ&#234;ncia da pandemia sobre esses pacientes&#44; especialmente quando se considera a estreita rela&#231;&#227;o entre a ativa&#231;&#227;o da UCE e o estado psicol&#243;gico dos pacientes&#46; Portanto&#44; nosso objetivo foi investigar o impacto da pandemia de COVID&#8208;19 no curso da UCE refrat&#225;ria&#44; juntamente com a ades&#227;o dos pacientes ao omalizumabe e ajustes no tratamento&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Popula&#231;&#227;o estudada e desenho do estudo</span><p id="par0025" class="elsevierStylePara elsevierViewall">Um total de 104 pacientes com UCE em tratamento com omalizumabe foram recrutados em ambulat&#243;rios de alergia para adultos de tr&#234;s hospitais terci&#225;rios em Istambul&#46; Os pacientes que n&#227;o compareceram &#224;s consultas de seguimento&#44; que n&#227;o tomaram as inje&#231;&#245;es de omalizumabe por diversos motivos antes da pandemia de COVID&#8208;19 e que foram diagnosticados como portadores de doen&#231;as psiqui&#225;tricas concomitantes e de neoplasias malignas n&#227;o foram inclu&#237;dos no estudo&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Os pacientes foram alocados em tr&#234;s grupos&#44; de acordo com seus padr&#245;es de uso do omalizumabe&#46; Assim&#44; foram determinados os pacientes que interromperam o tratamento com omalizumabe &#40;Grupo 1&#41;&#44; os pacientes que estenderam o intervalo de tempo entre as inje&#231;&#245;es subsequentes de omalizumabe &#40;Grupo 2&#41; e os pacientes que continuaram com as inje&#231;&#245;es regulares de omalizumabe &#40;Grupo 3&#41; durante o per&#237;odo do estudo&#46; Todos os indiv&#237;duos foram avaliados com os instrumentos do estudo no PQ e no RTPN&#46; Al&#233;m disso&#44; os dados de atividade da urtic&#225;ria avaliados pelo <span class="elsevierStyleItalic">Urticaria Activity Score</span> &#40;UAS7&#41; antes da pandemia &#40;AP&#41; foram obtidos dos prontu&#225;rios dos pacientes&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Avalia&#231;&#227;o da atividade da urtic&#225;ria e estado mental</span><p id="par0035" class="elsevierStylePara elsevierViewall">A atividade da doen&#231;a foi avaliada pelo UAS7&#44; um sistema simples de pontua&#231;&#227;o relatado pelo paciente&#46; Os pacientes avaliam a urtic&#225;ria pontuando a gravidade do prurido e o n&#250;mero de les&#245;es de 0 a 3 em sete dias consecutivos&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Os escores da UAS7 foram estratificados em cinco faixas de pontua&#231;&#227;o que descrevem a atividade da doen&#231;a variando de livre da urtic&#225;ria a urtic&#225;ria grave&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> A mudan&#231;a para uma faixa de escore de atividade da doen&#231;a mais alta foi definida como &#8220;aumento da atividade da urtic&#225;ria&#8221;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">O estado mental dos participantes foi determinado pela vers&#227;o turca da <span class="elsevierStyleItalic">Depression&#8208;Anxiety&#8208;Stress Scale</span> &#40;DASS&#8208;21&#41; e da escala <span class="elsevierStyleItalic">Fear of COVID&#8208;19</span> Scale &#40;FC&#8208;19s&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">15&#44;16</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">O DASS&#8208;21 &#233; um question&#225;rio autoaplic&#225;vel de 21 itens&#46; Os indiv&#237;duos avaliados indicam quanto as afirma&#231;&#245;es se aplicam a eles na &#250;ltima semana&#44; utilizando escala Likert que varia de 0 &#40;nunca&#41; a 3 &#40;na maioria das vezes&#44; sempre&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">O medo da COVID&#8208;19 foi avaliado com a escala FC&#8208;19s&#46; As respostas da FC&#8208;19s foram registradas na escala Likert de cinco pontos&#44; variando de &#8220;discordo totalmente&#8221; &#40;1&#41; a &#8220;concordo totalmente&#8221; &#40;5&#41;&#46; O escore mais alto representou maior medo da COVID&#8208;19&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Este estudo foi aprovado pelo Minist&#233;rio da Sa&#250;de da Turquia &#40;MST&#59; 2020&#8208;09&#8208;09T12&#95;40&#95;50&#41; e pelo conselho de revis&#227;o institucional e pelo Comit&#234; de &#201;tica do centro coordenador &#40;2021&#8208;96399&#41;&#46; O consentimento informado foi obtido de todos os participantes do estudo&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">An&#225;lise estat&#237;stica</span><p id="par0065" class="elsevierStylePara elsevierViewall">A an&#225;lise estat&#237;stica foi realizada com a vers&#227;o SPSS&#46;25 &#40;SPSS Inc&#46;&#44; Armonk&#44; NY&#44; EUA&#41;&#46; As vari&#225;veis categ&#243;ricas foram resumidas como frequ&#234;ncias e porcentagens&#46; As vari&#225;veis cont&#237;nuas foram dadas como m&#233;dia e desvio padr&#227;o ou mediana &#40;IIQ 25&#8208;75&#41;&#46; O teste de Wilcoxon foi usado para compara&#231;&#227;o de dados que n&#227;o apresentavam distribui&#231;&#227;o normal&#46; O teste U de Mann&#8208;Whitney e o teste de Kruskal&#8208;Wallis foram realizados para avaliar os diferentes grupos&#46; A rela&#231;&#227;o entre os escores da UAS7&#44; DASS&#8208;21 e FC&#8208;19s foi analisada pelo teste de correla&#231;&#227;o de Spearman&#46; O valor de p bilateral &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 determinou a signific&#226;ncia estat&#237;stica&#46; O <span class="elsevierStyleItalic">software</span> GraphPad Prism foi utilizado para an&#225;lise gr&#225;fica&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Resultados</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Caracter&#237;sticas cl&#237;nicas e demogr&#225;ficas dos pacientes com UCE</span><p id="par0070" class="elsevierStylePara elsevierViewall">Foram inclu&#237;dos no estudo 104 pacientes&#46; A m&#233;dia de idade foi de 42&#44;74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12 anos&#44; e a maioria &#40;74&#37;&#41; dos pacientes era do sexo feminino&#46; A dura&#231;&#227;o m&#233;dia da UCE era de quatro anos &#40;IIQ 25&#8208;75&#58; 3&#8208;8&#44;75&#41;&#44; e a dura&#231;&#227;o m&#233;dia do tratamento com omalizumabe foi de 24 meses &#40;IIQ 25&#8208;75&#58; 14&#8208;36&#44;75&#41;&#46; Cinquenta &#40;48&#44;1&#37;&#41; pacientes apresentavam urtic&#225;ria cr&#244;nica induzida concomitante&#44; como mostrado em detalhes na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46; O estresse foi o fator desencadeante mais comum &#40;51&#44;9&#37;&#41;&#44; enquanto infec&#231;&#245;es foram o fator desencadeante em 7&#44;7&#37; dos pacientes&#46; As caracter&#237;sticas demogr&#225;ficas e cl&#237;nicas dos 104 pacientes com UCE s&#227;o mostradas na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Compara&#231;&#227;o utilizando os instrumentos de estudo em todos os indiv&#237;duos entre os per&#237;odos da pandemia</span><p id="par0075" class="elsevierStylePara elsevierViewall">Os escores da UAS7 em todos os pacientes durante o PQ &#40;UAS7PQ&#41; foram significativamente maiores do que os determinados no RTPN &#40;UAS7RTPN&#41; e antes da pandemia &#40;UAS7AP&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; Na an&#225;lise <span class="elsevierStyleItalic">post hoc</span>&#44; a mediana da UAS7PQ foi maior do que os valores determinados antes da pandemia &#40;UAS7AP&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#44; enquanto os escores medianos da UAS7 foram semelhantes entre o PQ e o RTPN &#40;UAS7RTPN&#59; <a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Os escores da DASS&#8208;21 e FC&#8208;19s foram significativamente maiores durante o PQ em compara&#231;&#227;o ao RTPN &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#59; <a class="elsevierStyleCrossRefs" href="#fig0010">figs&#46; 2 e 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">O sexo feminino apresentou escores significativamente maiores na FC&#8208;19s &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;024&#41; durante o PQ&#44; enquanto os escores na UAS7 e DASS&#8208;21 n&#227;o diferiram entre os sexos&#46; Os escores na UAS7&#44; DASS&#8208;21&#44; FC&#8208;19s n&#227;o diferiram em rela&#231;&#227;o a idade&#44; escolaridade&#44; presen&#231;a de angioedema ou doen&#231;a cr&#244;nica durante os dois per&#237;odos &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Os escores na UAS7 e FC&#8208;19s foram correlacionados entre si durante o PQ e RTPN &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#44; R<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;228&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#44; R<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;227&#44; respectivamente&#59; <a class="elsevierStyleCrossRef" href="#fig0020">fig&#46; 4</a>&#41;&#44; enquanto os escores na UAS7 n&#227;o foram correlacionados com os escores na DASS&#8208; 21 &#40;<a class="elsevierStyleCrossRef" href="#fig0025">fig&#46; 5</a> A&#8208;B&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">A DASS&#8208;21 e FCV&#8208;19S foram correlacionadas entre si durante o PQ e RTPN &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#44; R<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;607&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#44; R<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;465&#44; respectivamente&#59; <a class="elsevierStyleCrossRef" href="#fig0030">fig&#46; 6</a> A&#8208;B&#41;&#46;</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Determina&#231;&#227;o dos grupos de estudo de acordo com a aplica&#231;&#227;o de omalizumabe durante a pandemia</span><p id="par0100" class="elsevierStylePara elsevierViewall">Setenta e seis pacientes receberam inje&#231;&#245;es de omalizumabe com os mesmos intervalos entre as doses &#40;Grupo 3&#41;&#46; Os intervalos entre as inje&#231;&#245;es foram prolongados em nove pacientes &#40;Grupo 2&#41;&#44; e 19 &#40;18&#44;3&#37;&#41; pacientes interromperam o uso de omalizumabe &#40;Grupo 1&#41;&#46; O motivo do prolongamento dos intervalos de omalizumabe foi o medo da COVID&#8208;19&#44; enquanto os motivos mais comuns para a interrup&#231;&#227;o do tratamento com omalizumabe foram o medo do COVID&#8208;19 e a dificuldade de comparecer aos hospitais&#46; Alguns pacientes apresentaram mais de um motivo para a interrup&#231;&#227;o do tratamento com omalizumabe durante o PQ &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46; Um total de 20&#37; dos pacientes do Grupo 3 tiveram suas inje&#231;&#245;es em outro centro&#44; diferente do seu centro inicial&#59; 2&#44;4&#37; fizeram terapia domiciliar&#44; e os demais continuaram em seu centro de tratamento inicial durante o per&#237;odo do estudo&#46; No Grupo 2&#44; a dura&#231;&#227;o m&#233;dia dos intervalos entre as doses de omalizumabe foi de oito semanas &#40;IIQ 25&#8208;75&#58; 6&#8208;8&#41;&#46; No Grupo 1&#44; a dura&#231;&#227;o mediana da interrup&#231;&#227;o do tratamento com omalizumabe foi de 16 semanas &#40;IIQ 25&#8208;75&#58; 14&#8208;19&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Compara&#231;&#227;o da atividade da urtic&#225;ria entre os grupos de pacientes antes da pandemia</span><p id="par0105" class="elsevierStylePara elsevierViewall">Os pacientes do Grupo 3 apresentaram m&#233;dia de UAS7AP maior do que os do Grupo 1 ou do Grupo 2 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;021&#41;&#46; A an&#225;lise <span class="elsevierStyleItalic">post hoc</span> revelou que a mediana da UAS7AP foi maior no Grupo 3 do que no Grupo 2 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#41;&#44; enquanto a mediana da UAS7AP foi semelhante entre os pacientes do Grupo 3 e os do Grupo 1 &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Compara&#231;&#227;o dos resultados do instrumento de estudo entre grupos de pacientes em dois per&#237;odos de pandemia</span><p id="par0110" class="elsevierStylePara elsevierViewall">No PQ&#44; a mediana da UAS7 foi diferente entre os tr&#234;s grupos &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Na an&#225;lise <span class="elsevierStyleItalic">post&#8208;hoc</span>&#44; a mediana da UAS7PQ foi maior nos pacientes do Grupo 1 &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; enquanto a mediana da UAS7QP foi semelhante entre os pacientes do Grupo 2 e os do Grupo 3 &#40;p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#59; <a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Nos tr&#234;s grupos&#44; a mediana da UAS7QP foi maior que a mediana da UAS7AP&#44; e esse aumento foi estatisticamente significativo nos pacientes do Grupo 1 &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e naqueles do Grupo 3 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;008&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Os escores da FC&#8208;19s e DASS&#8208;21 n&#227;o diferiram entre os tr&#234;s grupos no PQ &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">No RTPN&#44; observou&#8208;se que todos os pacientes do Grupo 1 reiniciaram o omalizumabe devido &#224; piora dos sintomas&#46; As medianas dos escores da UAS7&#44; FC&#8208;19s e DASS&#8208;21 n&#227;o foram diferentes entre os tr&#234;s grupos no RTPN &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Escores na FC&#8208;19s em pacientes com aumento da atividade da urtic&#225;ria durante o PQ</span><p id="par0130" class="elsevierStylePara elsevierViewall">Trinta e quatro &#40;32&#44;7&#37;&#41; pacientes apresentaram aumento da atividade da urtic&#225;ria durante o PQ&#46; Entre esses pacientes&#44; os escores da FC&#8208;19s durante o PQ e ter comorbidades associadas a COVID&#8208;19 mais grave foram estatisticamente maiores do que naqueles com atividade de urtic&#225;ria est&#225;vel &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;013 e p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#44; respectivamente&#41;&#46; Um total de 22&#44;4&#37; dos pacientes do Grupo 3 tiveram aumento da atividade da urtic&#225;ria durante o PQ&#44; e esses pacientes apresentaram escores de FC&#8208;19s mais altos em compara&#231;&#227;o com aqueles com atividade de doen&#231;a est&#225;vel &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;008&#41;&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discuss&#227;o</span><p id="par0135" class="elsevierStylePara elsevierViewall">Este &#233; o primeiro estudo que investiga o impacto da pandemia de COVID&#8208;19 em pacientes com UCE refrat&#225;ria tratados com omalizumabe&#46; Os achados do presente estudo revelaram que a pandemia de COVID&#8208;19 pode prejudicar o curso da UCE refrat&#225;ria e as interven&#231;&#245;es para apoiar os tratamentos em andamento s&#227;o&#44; portanto&#44; cruciais&#46; Al&#233;m disso&#44; ele fornece contribui&#231;&#227;o adicional &#224;s recomenda&#231;&#245;es da recente declara&#231;&#227;o da European Academy of Allergy and Clinical Immunology &#40;EAACI&#41; sobre tratamento com biol&#243;gicos na UCE durante a pandemia&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> mostrando que at&#233; oito semanas de intervalo entre inje&#231;&#245;es subsequentes de omalizumabe podem ser toleradas na UCE refrat&#225;ria durante a pandemia&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Os pacientes com UCE apresentam n&#237;veis mais altos de estresse&#44; e a atividade da doen&#231;a est&#225; correlacionada com os n&#237;veis de estresse emocional&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">18&#44;19</span></a> Estudo recente avaliou o impacto da pandemia em 509 pacientes com UCE leve&#47;moderada e revelou aumento da atividade da urtic&#225;ria e n&#237;veis mais altos de estresse durante o PQ em compara&#231;&#227;o com AP e RTPN&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> No presente estudo foi poss&#237;vel determinar o aumento da atividade da doen&#231;a em pacientes com UCE refrat&#225;ria que receberam omalizumabe durante a pandemia&#46; Como os dist&#250;rbios emocionais e os eventos estressantes da vida influenciam o curso da UCE&#44; pode&#8208;se especular que a pandemia de COVID&#8208;19 teria efeitos prejudiciais nos pacientes com UCE&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">O medo &#233; uma das caracter&#237;sticas das doen&#231;as infecciosas&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> Com a alta taxa de infec&#231;&#227;o e mortalidade relativamente alta&#44; os indiv&#237;duos podem se preocupar com a COVID&#8208;19&#46; A esse respeito&#44; utilizou&#8208;se a escala FC&#8208;19s&#44; que &#233; ferramenta v&#225;lida para avaliar o medo da COVID&#8208;19 e est&#225; correlacionada significativamente com depress&#227;o e ansiedade&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> Shin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> tamb&#233;m afirmaram que o neurocircuito do medo&#47;ansiedade tem sobreposi&#231;&#227;o e intera&#231;&#227;o com o neurocircuito que orquestra a resposta ao estresse&#46; No presente estudo&#44; os escores da FC&#8208;19s foram significativamente maiores durante o PQ em compara&#231;&#227;o ao RTPN&#44; e os escores da FC&#8208;19s foram correlacionados com os escores da escala DASS&#8208;21&#46; Al&#233;m disso&#44; entre os pacientes que continuaram o tratamento com omalizumabe&#44; aqueles que apresentaram aumento da atividade da urtic&#225;ria apresentaram escores mais altos de FC&#8208;19s no PQ&#44; indicando o impacto do medo no curso da UCE&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">A resposta a um fator de estresse psicossocial &#233; diferente entre os sexos&#46; A redu&#231;&#227;o do condicionamento do medo &#233; observada em homens estressados&#44; enquanto as mulheres estressadas podem mostrar reconhecimento aumentado do medo&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">23&#44;24</span></a> Essa pode ser a prov&#225;vel explica&#231;&#227;o para o fato de as pacientes do sexo feminino apresentarem escores de FC&#8208;19s mais altos&#44; enquanto os escores na escala DASS&#8208;21 n&#227;o foram diferentes dos observados nos homens&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">As medidas de conten&#231;&#227;o&#44; como redu&#231;&#227;o de visitas a hospitais e isolamento domiciliar implementadas para evitar a propaga&#231;&#227;o dessa doen&#231;a altamente contagiosa&#44; tornaram&#8208;se obst&#225;culo para o seguimento e tratamento de doen&#231;as cr&#244;nicas&#46; De maneira similar&#44; Kocat&#252;rk et al&#46; afirmaram que o n&#250;mero semanal de pacientes de urtic&#225;ria cr&#244;nica &#40;UC&#41; tratados nos centros UCARE diminuiu mais de 50&#37; durante a pandemia de COVID&#8208;19&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Estudo avaliando os efeitos da pandemia em pacientes com UC revelou 44&#37; de interrup&#231;&#227;o do tratamento com omalizumabe&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> No presente estudo&#44; 81&#44;7&#37; dos pacientes continuaram com omalizumabe&#46; Essa taxa de ades&#227;o relativamente mais alta pode ser atribu&#237;da aos regulamentos nas cl&#237;nicas do presente estudo para a continua&#231;&#227;o dos tratamentos em andamento com omalizumabe durante a pandemia&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">O omalizumabe s&#243; pode ser injetado em hospitais mediante receita m&#233;dica na Turquia&#46; Durante o PQ&#44; o MST facilitou o acesso &#224; medica&#231;&#227;o prescrita para aqueles que tinham relat&#243;rios de consentimento de prescri&#231;&#227;o v&#225;lidos&#46; Pela facilita&#231;&#227;o do acesso &#224; medica&#231;&#227;o prescrita&#44; 20&#37; dos pacientes do presente estudo continuaram suas inje&#231;&#245;es em diferentes centros al&#233;m do centro de sa&#250;de inicial&#44; enquanto 2&#44;4&#37; dos pacientes fizeram terapia domiciliar&#46; Nesse ponto&#44; deve&#8208;se enfatizar a import&#226;ncia da aten&#231;&#227;o espec&#237;fica para interven&#231;&#245;es personalizadas em rela&#231;&#227;o a medicamentos utilizados em doen&#231;as cr&#244;nicas durante per&#237;odos especiais&#44; como surtos de doen&#231;as&#44; a fim de manter o acompanhamento e o tratamento efetivos&#46; Em estudo recente de &#214;zt&#252;rk et al&#46;&#44; eles afirmaram que 59&#37; dos alergistas de adultos&#47;pedi&#225;tricos na Turquia utilizavam a telemedicina para o tratamento de pacientes com urtic&#225;ria&#47;angioedema&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">A recente declara&#231;&#227;o da EAACI sobre o uso de produtos biol&#243;gicos durante a COVID&#8208;19 aconselhou a n&#227;o alterar a terapia em indiv&#237;duos n&#227;o infectados com base na opini&#227;o de especialistas&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> Entretanto&#44; ajustes bem&#8208;sucedidos no tratamento com omalizumabe foram demonstrados em pacientes com UCE refrat&#225;ria antes da pandemia&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">28&#8211;30</span></a> No presente estudo&#44; foi demonstrado pela primeira vez que os ajustes de intervalo entre doses podem ser tolerados em pacientes com UCE refrat&#225;ria durante a pandemia&#44; mas a interrup&#231;&#227;o pode piorar o curso da doen&#231;a&#46; Os pacientes com intervalos prolongados entre doses de omalizumabe apresentaram escores mais altos na UAS7AP&#46; Portanto&#44; o prolongamento do intervalo pode ser recomendado para pacientes com bom controle da urtic&#225;ria&#44; a fim de reduzir as visitas hospitalares durante a pandemia&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Por outro lado&#44; 78&#44;9&#37; dos pacientes que interromperam o uso de omalizumabe apresentaram aumento da atividade da urtic&#225;ria&#46; Como os pacientes do presente estudo tinham UCE refrat&#225;ria&#44; era esperada a perda do controle da doen&#231;a quando o omalizumabe foi interrompido&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">A COVID&#8208;19 tem sido um risco para todos os seres humanos&#44; e comorbidades como diabetes <span class="elsevierStyleItalic">mellitus</span>&#44; hipertens&#227;o&#44; doen&#231;as cardiovasculares e doen&#231;as respirat&#243;rias cr&#244;nicas foram identificadas como fatores de risco para COVID&#8208;19 grave&#46; No presente estudo&#44; os pacientes com essas comorbidades apresentaram maiores escores nas escalas UAS7&#44; DASS&#8208;21&#44; FC&#8208;19s&#44; mas n&#227;o foram estatisticamente significativos&#46; Apesar disso&#44; 47&#44;1&#37; deles tiveram aumento de atividade da urtic&#225;ria durante o PQ&#44; e isso &#233; estatisticamente significativo quando comparados aos pacientes sem comorbidades&#46; Pode&#8208;se especular que o conhecimento de ter comorbidades que s&#227;o associadas &#224; infec&#231;&#227;o grave por COVID&#8208;19 resultou na perda do controle da doen&#231;a&#44; o que pode ser outro indicador da associa&#231;&#227;o de medo e estresse com atividade de urtic&#225;ria&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Houve duas limita&#231;&#245;es no presente estudo&#46; A primeira &#233; o pequeno tamanho da amostra de pacientes com intervalos prolongados entre doses de omalizumabe&#44; o que pode ter afetado a acur&#225;cia dos resultados estat&#237;sticos&#46; Recomenda&#8208;se aos pacientes que n&#227;o alterem a terapia&#44; de acordo com a declara&#231;&#227;o da EAACI&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> Os pacientes do Grupo 2 prolongaram os intervalos independentemente das sugest&#245;es m&#233;dicas&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Como segunda limita&#231;&#227;o&#44; n&#227;o foi poss&#237;vel avaliar a sa&#250;de mental dos pacientes com as mesmas ferramentas anteriores ao estudo&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclus&#227;o</span><p id="par0195" class="elsevierStylePara elsevierViewall">Foi observado que tanto o medo quanto o estresse induzidos pela COVID&#8208;19 e a interrup&#231;&#227;o do tratamento com omalizumabe produziram aumento na atividade da urtic&#225;ria&#46; Portanto&#44; os pacientes recebendo omalizumabe devem continuar seu tratamento com os mesmos intervalos de dose ou intervalos prolongados&#59; interven&#231;&#245;es personalizadas&#44; como telemedicina e terapia domiciliar&#44; devem ser consideradas para pacientes com doen&#231;as cr&#244;nicas durante per&#237;odos de surtos de doen&#231;as&#44; a fim de manter acompanhamento eficaz e reduzir visitas desnecess&#225;rias aos hospitais&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Suporte financeiro</span><p id="par0200" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Contribui&#231;&#227;o dos autores</span><p id="par0205" class="elsevierStylePara elsevierViewall">M&#252;ge Olga&#231;&#58; Fez contribui&#231;&#245;es substanciais para concep&#231;&#227;o e planejamento&#44; obten&#231;&#227;o dos dados&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participou na reda&#231;&#227;o do manuscrito&#44; e revis&#227;o cr&#237;tica do conte&#250;do intelectual importante&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Osman Ozan Ye&#287;it&#58; Fez contribui&#231;&#245;es substanciais na obten&#231;&#227;o de dados&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participou na reda&#231;&#227;o do manuscrito&#44; e revis&#227;o cr&#237;tica do conte&#250;do intelectual importante&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Sengul Beyaz&#58; Fez contribui&#231;&#245;es substanciais para a obten&#231;&#227;o dos dados&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participou da reda&#231;&#227;o do manuscrito&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">&#214;zdemir Can T&#252;zer&#58; Fez contribui&#231;&#245;es substanciais para a obten&#231;&#227;o dos dados&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participou da reda&#231;&#227;o do manuscrito&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Deniz Eyice Karabacak&#58; Fez contribui&#231;&#245;es substanciais para a concep&#231;&#227;o e planejamento&#44; obten&#231;&#227;o dos dados&#44; participou na reda&#231;&#227;o do manuscrito&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Nida Oztop&#58; Fez contribui&#231;&#245;es substanciais para a obten&#231;&#227;o dos dados&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participou da reda&#231;&#227;o do manuscrito&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Pelin Karada&#287;&#58; Fez contribui&#231;&#245;es substanciais para a obten&#231;&#227;o dos dados&#44; interpreta&#231;&#227;o dos dados&#59; participou da reda&#231;&#227;o do manuscrito&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Raif Co&#351;kun&#58; Fez contribui&#231;&#245;es substanciais para concep&#231;&#227;o e planejamento&#44; obten&#231;&#227;o dos dados ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participou da reda&#231;&#227;o do manuscrito&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Semra Demir&#58; Fez contribui&#231;&#245;es substanciais para concep&#231;&#227;o e planejamento&#44; obten&#231;&#227;o dos dados&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participou na reda&#231;&#227;o do manuscrito e na revis&#227;o cr&#237;tica do conte&#250;do intelectual importante&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">Bahauddin Colakoglu&#58; Fez contribui&#231;&#245;es substanciais para concep&#231;&#227;o e planejamento&#44; obten&#231;&#227;o dos dados&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participou na reda&#231;&#227;o do manuscrito ou na revis&#227;o cr&#237;tica do conte&#250;do intelectual importante&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">Suna Buyukozturk&#58; Fez contribui&#231;&#245;es substanciais para concep&#231;&#227;o e planejamento&#44; aquisi&#231;&#227;o dos dados&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participou na revis&#227;o cr&#237;tica do manuscrito para conte&#250;do intelectual importante&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Asl&#305; Gelincik&#58; Fez contribui&#231;&#245;es substanciais para concep&#231;&#227;o e planejamento&#44; aquisi&#231;&#227;o dos dados&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participou na revis&#227;o cr&#237;tica do manuscrito para o conte&#250;do intelectual importante&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflito de interesses</span><p id="par0265" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">O curso da urtic&#225;ria cr&#244;nica espont&#226;nea &#40;UCE&#41; pode ser influenciado por infec&#231;&#245;es&#44; depress&#227;o e estresse&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">O objetivo do estudo foi investigar o impacto da pandemia de COVID&#8208;19 no curso da UCE refrat&#225;ria&#44; juntamente com a ades&#227;o dos pacientes ao omalizumabe e ajustes no tratamento&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A escala <span class="elsevierStyleItalic">Urtic&#225;ria Activity Score</span> &#40;UAS7&#41; foi utilizada para avaliar a atividade da doen&#231;a&#46; As escalas <span class="elsevierStyleItalic">Fear of COVID&#8208;19</span> &#40;FC&#8208;19s&#41; e <span class="elsevierStyleItalic">Depression Anxiety Stress Scale</span> &#40;DASS&#8208;21&#41; foram utilizadas para avaliar o estado de sa&#250;de mental&#46; Todas as escalas foram utilizadas durante o per&#237;odo de quarentena &#40;PQ&#41; e retorno ao per&#237;odo normal &#40;RTPN&#41;&#46; A escala UAS7 antes da pandemia &#40;AP&#41; foi registrada a partir dos prontu&#225;rios dos pacientes&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Foram avaliados 104 pacientes com UCE recebendo omalizumabe&#46; Os escores da UAS7 durante o PQ foram significativamente maiores do que os do RTPN e AP &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; Os escores da DASS&#8208;21 e FC&#8208;19 foram significativamente maiores durante o PQ em compara&#231;&#227;o ao RTPN &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; Dezenove &#40;18&#44;2&#37;&#41; pacientes interromperam o tratamento com omalizumabe&#44; e nove pacientes prolongaram os intervalos entre as doses subsequentes durante a pandemia&#46; Os escores da UAS7 no PQ foram significativamente maiores nos pacientes que interromperam o tratamento com omalizumabe do que naqueles que continuaram &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Entre os pacientes que continuaram o tratamento com omalizumabe&#44; 22&#44;4&#37; tiveram aumento da atividade da urtic&#225;ria e maiores escores na escala FC&#8208;19 em compara&#231;&#227;o com aqueles com atividade de doen&#231;a est&#225;vel &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;008&#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 tamanho da amostra de pacientes com intervalos prolongados de omalizumabe e a falta de avalia&#231;&#227;o da sa&#250;de mental com os mesmos instrumentos anteriores ao estudo&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">O medo induzido pela COVID&#8208;19 pode gerar aumento na atividade da doen&#231;a&#46; Portanto&#44; os pacientes em uso de omalizumabe devem continuar seu tratamento&#44; e intervalos prolongados sem omalizumabe podem ser considerados em pacientes com bom controle da urtic&#225;ria&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Olga&#231; M&#44; Ye&#287;it OO&#44; Beyaz &#350;&#44; &#214;ztop N&#44; T&#252;zer C&#44; Eyice D&#44; et al&#46; Impact of COVID&#8208;19 pandemic on the course of refractory chronic spontaneous urticaria under omalizumab treatment&#46; An Bras Dermatol&#46; 2023&#59;98&#58;189&#8211;97&#46;</p>"
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        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Trabalho realizado na Divis&#227;o de Imunologia e Doen&#231;as Al&#233;rgicas&#44; &#350;i&#351;li Hamidiye Etfal Research and Education Hospital&#59; Divis&#227;o de Imunologia e Doen&#231;as Al&#233;rgicas&#44; Departamento de Cl&#237;nica M&#233;dica&#44; Faculdade de Medicine de Istambul&#44; Istanbul University&#44; e Divis&#227;o de Imunologia e Doen&#231;as Al&#233;rgicas&#44; Okmeydan&#305; Research and Education Hospital&#44; Istambul&#44; Turquia&#46;</p>"
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          "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Compara&#231;&#227;o das medianas dos escores da UAS&#8208;7 AP&#44; no PQ&#44; e RTPN&#46; UAS&#8208;7&#44; <span class="elsevierStyleItalic">Urticaria Activity Score</span> somado ao longo de 7 dias&#59; IIQ&#44; intervalo interquartil&#59; AP&#44; antes da pandemia&#59; PQ&#44; per&#237;odo da quarentena&#59; RTPN&#44; retorno ao per&#237;odo normal&#59; NS&#44; n&#227;o significante&#46;</p>"
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          "pt" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Compara&#231;&#227;o da mediana dos escores da DASS&#8208;21 no PQ and RTPN&#46; DASS&#8208;21&#44; <span class="elsevierStyleItalic">Depression Anxiety and Stress Scale</span>&#59; IIQ&#44; intervalo interquartil&#59; PQ&#44; per&#237;odo da quarentena&#59; RTPN&#44; retorno ao per&#237;odo normal&#46;</p>"
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          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Compara&#231;&#227;o da m&#233;dia dos escores da FC&#8208;19s no PQ e RTPN&#46; FC&#8208;19s&#44; <span class="elsevierStyleItalic">Fear of COVID&#8208;19 scale</span>&#59; PQ&#44; per&#237;odo da quarentena&#59; RTPN&#44; retorno ao per&#237;odo normal&#59; DP&#44; desvio&#8208;padr&#227;o&#46;</p>"
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          "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Correla&#231;&#227;o dos escores da UAS7 e FC&#8208;19s no PQ&#46; &#40;B&#41; Correla&#231;&#227;o dos escores da UAS7 e FC&#8208;19s no RTPN&#46; UAS&#8208;7&#44; <span class="elsevierStyleItalic">Urticaria Activity Score</span> somado ao longo de 7 dias&#59; FC&#8208;19s&#44; <span class="elsevierStyleItalic">Fear of COVID&#8208;19 scale&#59;</span> PQ&#44; per&#237;odo de quarentena&#59; RTPN&#44; retorno ao per&#237;odo normal&#46;</p>"
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        "mostrarFloat" => true
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          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Correla&#231;&#227;o dos escores da DASS&#8208;21 e UAS7 no PQ&#46; &#40;B&#41; Correla&#231;&#227;o dos escores da DASS&#8208;21 e UAS7 no RTPN&#46; DASS&#8208;21&#44; <span class="elsevierStyleItalic">Depression Anxiety and Stress Scale</span>&#59; UAS&#8208;7&#44; Seven days urticaria activity score&#59; PQ&#44; per&#237;odo de quarentena&#59; RTPN&#44; retorno ao per&#237;odo normal&#46;</p>"
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        "mostrarFloat" => true
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          "pt" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Correla&#231;&#227;o dos escores da DASS&#8208;21 e FC&#8208;19s no PQ&#46; &#40;B&#41; Correla&#231;&#227;o dos escores da DASS&#8208;21 e FC&#8208;19s no RTPN&#46; DASS&#8208;21&#44; <span class="elsevierStyleItalic">Depression Anxiety and Stress Scale</span>&#59; FC&#8208;19s&#44; <span class="elsevierStyleItalic">Fear of COVID&#8208;19 scale&#59;</span> PQ&#44; per&#237;odo de quarentena&#59; RTPN&#44; retorno ao per&#237;odo normal&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Idade&#44;</span> m&#233;dia anos<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">42&#44;74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Sexo&#44; n &#40;&#37;&#41;</span></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">77 &#40;74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Doen&#231;a concomitante&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46 &#40;44&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Doen&#231;as cardiovasculares&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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 &#40;3&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Doen&#231;as respirat&#243;rias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;9&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Doen&#231;as da tireoide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;9&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipertens&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;9&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Arritmia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diabetes <span class="elsevierStyleItalic">mellitus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;12&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hiperlipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;5&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Outras&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;7&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Dura&#231;&#227;o da urtic&#225;ria&#44; anos&#44; mediana &#40;IIQ 25</span>&#8208;<span class="elsevierStyleBold">75&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;3&#8208;8&#44;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Dura&#231;&#227;o do uso de omalizumabe&#44; meses&#44; mediana &#40;IIQ 25</span>&#8208;<span class="elsevierStyleBold">75&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;14&#8208;36&#44;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Presen&#231;a de angioedema&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66 &#40;63&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Presen&#231;a de urtic&#225;ria induzida&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;48&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urtic&#225;ria ao frio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;12&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urtic&#225;ria solar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;29&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urtic&#225;ria aquag&#234;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urtic&#225;ria de press&#227;o tardia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;17&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urtic&#225;ria vibrat&#243;ria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urtic&#225;ria colin&#233;rgica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;12&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urtic&#225;ria de contato&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dermografismo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;22&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Presen&#231;a de fatores desencadeantes&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68 &#40;65&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Medicamentos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;21&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alimentos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;29&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estresse&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;51&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Infec&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;7&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Outros&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;6&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">FC&#8208;19 &#40;m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&#41;</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DASS&#8208;21t mediana &#40;IIQ&#58; 25&#8208;75&#41;</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">RTPN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">RTPN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">RTPN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Sexo</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Feminino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;0&#8208;5&#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">5 &#40;0&#8208;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;0&#8208;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44;25<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#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">17&#44;31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;2&#44;5&#8208;14&#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">3 &#40;1&#8208;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;0&#8208;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;0&#8208;12&#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">4 &#40;0&#8208;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">15&#44;04<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;0&#8208;14&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">NS&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">NS&nbsp;\t\t\t\t\t\t\n
                  \t\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">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Idade</span></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"><span class="elsevierStyleHsp" style=""></span>18&#8208;40&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;0&#8208;5&#44;25&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#44;5 &#40;0&#8208;14&#44;25&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;0&#8208;7&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18&#44;45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;66&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16&#44;64<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;49&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">8 &#40;1&#8208;14&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;0&#8208;10&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>40&#8208;65&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">4 &#40;0&#8208;8&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;0&#8208;19&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;0&#8208;12&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18&#44;34<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;52&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><td class="td" title="\n
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                  \t\t\t\t">7 &#40;1&#44;5&#8208;13&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;1&#8208;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62; 65&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 &#40;0&#8208;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#8208;21&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\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"><span class="elsevierStyleBold">Presen&#231;a de angioedema</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \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
                  \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">p&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  " align="left" valign="\n
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                  \t\t\t\t">NS&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\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Presen&#231;a de doen&#231;as cr&#244;nicas</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1 &#40;0&#8208;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&#44;5 &#40;0&#8208;21&#44;75&#41;&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">18&#44;67<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;44&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16&#44;67<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;02&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">6 &#40;1&#8208;11&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;0&#8208;8&#44;25&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
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          "pt" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">UAS7&#44; DASS&#8208;21s&#44; FC&#8208;19s dos pacientes de acordo com caracter&#237;sticas demogr&#225;ficas e cl&#237;nicas</p>"
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                  \t\t\t\t">PQ&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">RTPN&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;0&#8208;21&#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">PQ&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RTPN&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PQ&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</td><td class="td" title="\n
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                  \t\t\t\t">5&#44;5&#40;1&#8208;14&#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">NS&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">RTPN&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">4 &#40;0&#8208;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;0&#8208;4&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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          "pt" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Escores de UAS7&#44; DASS&#8208;21s&#44; e FC&#8208;19s de tr&#234;s grupos de pacientes AP&#44; no PQ e no RTPN</p>"
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Artigo original
Impacto da pandemia de COVID‐19 no curso da urticária crônica espontânea refratária em tratamento com omalizumabe
Müge Olgaça,
Autor para correspondência
drmugeolgac@yahoo.com.tr

Autor para correspondência.
, Osman Ozan Yeğitb, Şengül Beyazb, Nida Öztopb, Can Tüzerb, Deniz Eyiceb, Pelin Karadağb, Raif Coşkunc, Semra Demirb, Bahaauddin Çolakoğlub, Suna Büyüköztürkb, Aslı Gelincikb
a Divisão de Imunologia e Doenças Alérgicas, Şişli Hamidiye Etfal Research and Education Hospital, Istambul, Turquia
b Divisão de Imunologia e Doenças Alérgicas, Departamento de Clínica Médica, Faculdade de Medicine de Istambul, Istanbul University, Istambul, Turquia
c Divisão de Imunologia e Doenças Alérgicas, Okmeydanı Research and Education Hospital, Istambul, Turquia
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emerg&#234;ncia de sa&#250;de p&#250;blica de interesse internacional&#44; uma pandemia&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> diversas consequ&#234;ncias cl&#237;nicas entraram em cena&#46; Essa doen&#231;a infecciosa imprevis&#237;vel e de r&#225;pida dissemina&#231;&#227;o vem causando preocupa&#231;&#227;o universal&#44; mas tamb&#233;m ansiedade e ang&#250;stia&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> Como estudos anteriores elucidaram que o bem&#8208;estar mental havia sido afetado durante os surtos da doen&#231;a&#44; &#233; esperado que os resultados psicossom&#225;ticos adversos aumentem&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#8211;12</span></a> O aspecto psicol&#243;gico da COVID&#8208;19 em termos de medo&#44; estresse&#44; ansiedade e depress&#227;o ainda n&#227;o foi completamente esclarecido&#44; especialmente em pacientes com doen&#231;as cr&#244;nicas&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Ap&#243;s a detec&#231;&#227;o do primeiro caso de COVID&#8208;19 na Turquia em 9 de mar&#231;o de 2020&#44; v&#225;rias medidas de conten&#231;&#227;o&#44; como distanciamento social&#44; restri&#231;&#245;es de viagem e fechamento de escolas e locais de trabalho&#44; foram implementadas&#46; Esse &#8220;per&#237;odo de quarentena &#40;PQ&#41;&#8221; durou tr&#234;s meses&#46; &#192; medida que o n&#250;mero de casos diminuiu at&#233; o final de maio de 2020&#44; as restri&#231;&#245;es diminu&#237;ram gradualmente em um esfor&#231;o para manter a rotina di&#225;ria&#46; Esse &#8220;retorno ao per&#237;odo normal &#40;RTPN&#41;&#8221; durou tr&#234;s meses&#44; at&#233; o final de agosto de 2020&#46; Os comportamentos dos pacientes com doen&#231;as cr&#244;nicas foram fortemente afetados durante a pandemia&#44; considerando sua ades&#227;o aos medicamentos e comparecimento &#224;s consultas de seguimento&#59; entretanto&#44; n&#227;o h&#225; dados documentados demonstrando as consequ&#234;ncias das restri&#231;&#245;es no comportamento de pacientes com doen&#231;as cr&#244;nicas&#46; Tamb&#233;m se pode esperar que os pacientes com UCE sejam afetados de maneira semelhante pela pandemia&#44; 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antes da pandemia &#40;AP&#41; foram obtidos dos prontu&#225;rios dos pacientes&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Avalia&#231;&#227;o da atividade da urtic&#225;ria e estado mental</span><p id="par0035" class="elsevierStylePara elsevierViewall">A atividade da doen&#231;a foi avaliada pelo UAS7&#44; um sistema simples de pontua&#231;&#227;o relatado pelo paciente&#46; Os pacientes avaliam a urtic&#225;ria pontuando a gravidade do prurido e o n&#250;mero de les&#245;es de 0 a 3 em sete dias consecutivos&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Os escores da UAS7 foram estratificados em cinco faixas de pontua&#231;&#227;o que descrevem a atividade da doen&#231;a variando de livre da urtic&#225;ria a urtic&#225;ria grave&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> A mudan&#231;a para uma faixa de escore de atividade da doen&#231;a mais alta foi definida como &#8220;aumento da atividade da urtic&#225;ria&#8221;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">O estado mental dos participantes foi determinado pela vers&#227;o turca da <span class="elsevierStyleItalic">Depression&#8208;Anxiety&#8208;Stress Scale</span> &#40;DASS&#8208;21&#41; e da escala <span class="elsevierStyleItalic">Fear of COVID&#8208;19</span> Scale &#40;FC&#8208;19s&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">15&#44;16</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">O DASS&#8208;21 &#233; um question&#225;rio autoaplic&#225;vel de 21 itens&#46; Os indiv&#237;duos avaliados indicam quanto as afirma&#231;&#245;es se aplicam a eles na &#250;ltima semana&#44; utilizando escala Likert que varia de 0 &#40;nunca&#41; a 3 &#40;na maioria das vezes&#44; sempre&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">O medo da COVID&#8208;19 foi avaliado com a escala FC&#8208;19s&#46; As respostas da FC&#8208;19s foram registradas na escala Likert de cinco pontos&#44; variando de &#8220;discordo totalmente&#8221; &#40;1&#41; a &#8220;concordo totalmente&#8221; &#40;5&#41;&#46; O escore mais alto representou maior medo da COVID&#8208;19&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Este estudo foi aprovado pelo Minist&#233;rio da Sa&#250;de da Turquia &#40;MST&#59; 2020&#8208;09&#8208;09T12&#95;40&#95;50&#41; e pelo conselho de revis&#227;o institucional e pelo Comit&#234; de &#201;tica do centro coordenador &#40;2021&#8208;96399&#41;&#46; O consentimento informado foi obtido de todos os participantes do estudo&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">An&#225;lise estat&#237;stica</span><p id="par0065" class="elsevierStylePara elsevierViewall">A an&#225;lise estat&#237;stica foi realizada com a vers&#227;o SPSS&#46;25 &#40;SPSS Inc&#46;&#44; Armonk&#44; NY&#44; EUA&#41;&#46; As vari&#225;veis categ&#243;ricas foram resumidas como frequ&#234;ncias e porcentagens&#46; As vari&#225;veis cont&#237;nuas foram dadas como m&#233;dia e desvio padr&#227;o ou mediana &#40;IIQ 25&#8208;75&#41;&#46; O teste de Wilcoxon foi usado para compara&#231;&#227;o de dados que n&#227;o apresentavam distribui&#231;&#227;o normal&#46; O teste U de Mann&#8208;Whitney e o teste de Kruskal&#8208;Wallis foram realizados para avaliar os diferentes grupos&#46; A rela&#231;&#227;o entre os escores da UAS7&#44; DASS&#8208;21 e FC&#8208;19s foi analisada pelo teste de correla&#231;&#227;o de Spearman&#46; O valor de p bilateral &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 determinou a signific&#226;ncia estat&#237;stica&#46; O <span class="elsevierStyleItalic">software</span> GraphPad Prism foi utilizado para an&#225;lise gr&#225;fica&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Resultados</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Caracter&#237;sticas cl&#237;nicas e demogr&#225;ficas dos pacientes com UCE</span><p id="par0070" class="elsevierStylePara elsevierViewall">Foram inclu&#237;dos no estudo 104 pacientes&#46; A m&#233;dia de idade foi de 42&#44;74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12 anos&#44; e a maioria &#40;74&#37;&#41; dos pacientes era do sexo feminino&#46; A dura&#231;&#227;o m&#233;dia da UCE era de quatro anos &#40;IIQ 25&#8208;75&#58; 3&#8208;8&#44;75&#41;&#44; e a dura&#231;&#227;o m&#233;dia do tratamento com omalizumabe foi de 24 meses &#40;IIQ 25&#8208;75&#58; 14&#8208;36&#44;75&#41;&#46; Cinquenta &#40;48&#44;1&#37;&#41; pacientes apresentavam urtic&#225;ria cr&#244;nica induzida concomitante&#44; como mostrado em detalhes na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46; O estresse foi o fator desencadeante mais comum &#40;51&#44;9&#37;&#41;&#44; enquanto infec&#231;&#245;es foram o fator desencadeante em 7&#44;7&#37; dos pacientes&#46; As caracter&#237;sticas demogr&#225;ficas e cl&#237;nicas dos 104 pacientes com UCE s&#227;o mostradas na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Compara&#231;&#227;o utilizando os instrumentos de estudo em todos os indiv&#237;duos entre os per&#237;odos da pandemia</span><p id="par0075" class="elsevierStylePara elsevierViewall">Os escores da UAS7 em todos os pacientes durante o PQ &#40;UAS7PQ&#41; foram significativamente maiores do que os determinados no RTPN &#40;UAS7RTPN&#41; e antes da pandemia &#40;UAS7AP&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; Na an&#225;lise <span class="elsevierStyleItalic">post hoc</span>&#44; a mediana da UAS7PQ foi maior do que os valores determinados antes da pandemia &#40;UAS7AP&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#44; enquanto os escores medianos da UAS7 foram semelhantes entre o PQ e o RTPN &#40;UAS7RTPN&#59; <a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Os escores da DASS&#8208;21 e FC&#8208;19s foram significativamente maiores durante o PQ em compara&#231;&#227;o ao RTPN &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#59; <a class="elsevierStyleCrossRefs" href="#fig0010">figs&#46; 2 e 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">O sexo feminino apresentou escores significativamente maiores na FC&#8208;19s &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;024&#41; durante o PQ&#44; enquanto os escores na UAS7 e DASS&#8208;21 n&#227;o diferiram entre os sexos&#46; Os escores na UAS7&#44; DASS&#8208;21&#44; FC&#8208;19s n&#227;o diferiram em rela&#231;&#227;o a idade&#44; escolaridade&#44; presen&#231;a de angioedema ou doen&#231;a cr&#244;nica durante os dois per&#237;odos &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Os escores na UAS7 e FC&#8208;19s foram correlacionados entre si durante o PQ e RTPN &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#44; R<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;228&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#44; R<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;227&#44; respectivamente&#59; <a class="elsevierStyleCrossRef" href="#fig0020">fig&#46; 4</a>&#41;&#44; enquanto os escores na UAS7 n&#227;o foram correlacionados com os escores na DASS&#8208; 21 &#40;<a class="elsevierStyleCrossRef" href="#fig0025">fig&#46; 5</a> A&#8208;B&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">A DASS&#8208;21 e FCV&#8208;19S foram correlacionadas entre si durante o PQ e RTPN &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#44; R<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;607&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#44; R<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;465&#44; respectivamente&#59; <a class="elsevierStyleCrossRef" href="#fig0030">fig&#46; 6</a> A&#8208;B&#41;&#46;</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Determina&#231;&#227;o dos grupos de estudo de acordo com a aplica&#231;&#227;o de omalizumabe durante a pandemia</span><p id="par0100" class="elsevierStylePara elsevierViewall">Setenta e seis pacientes receberam inje&#231;&#245;es de omalizumabe com os mesmos intervalos entre as doses &#40;Grupo 3&#41;&#46; Os intervalos entre as inje&#231;&#245;es foram prolongados em nove pacientes &#40;Grupo 2&#41;&#44; e 19 &#40;18&#44;3&#37;&#41; pacientes interromperam o uso de omalizumabe &#40;Grupo 1&#41;&#46; O motivo do prolongamento dos intervalos de omalizumabe foi o medo da COVID&#8208;19&#44; enquanto os motivos mais comuns para a interrup&#231;&#227;o do tratamento com omalizumabe foram o medo do COVID&#8208;19 e a dificuldade de comparecer aos hospitais&#46; Alguns pacientes apresentaram mais de um motivo para a interrup&#231;&#227;o do tratamento com omalizumabe durante o PQ &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46; Um total de 20&#37; dos pacientes do Grupo 3 tiveram suas inje&#231;&#245;es em outro centro&#44; diferente do seu centro inicial&#59; 2&#44;4&#37; fizeram terapia domiciliar&#44; e os demais continuaram em seu centro de tratamento inicial durante o per&#237;odo do estudo&#46; No Grupo 2&#44; a dura&#231;&#227;o m&#233;dia dos intervalos entre as doses de omalizumabe foi de oito semanas &#40;IIQ 25&#8208;75&#58; 6&#8208;8&#41;&#46; No Grupo 1&#44; a dura&#231;&#227;o mediana da interrup&#231;&#227;o do tratamento com omalizumabe foi de 16 semanas &#40;IIQ 25&#8208;75&#58; 14&#8208;19&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Compara&#231;&#227;o da atividade da urtic&#225;ria entre os grupos de pacientes antes da pandemia</span><p id="par0105" class="elsevierStylePara elsevierViewall">Os pacientes do Grupo 3 apresentaram m&#233;dia de UAS7AP maior do que os do Grupo 1 ou do Grupo 2 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;021&#41;&#46; A an&#225;lise <span class="elsevierStyleItalic">post hoc</span> revelou que a mediana da UAS7AP foi maior no Grupo 3 do que no Grupo 2 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#41;&#44; enquanto a mediana da UAS7AP foi semelhante entre os pacientes do Grupo 3 e os do Grupo 1 &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Compara&#231;&#227;o dos resultados do instrumento de estudo entre grupos de pacientes em dois per&#237;odos de pandemia</span><p id="par0110" class="elsevierStylePara elsevierViewall">No PQ&#44; a mediana da UAS7 foi diferente entre os tr&#234;s grupos &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Na an&#225;lise <span class="elsevierStyleItalic">post&#8208;hoc</span>&#44; a mediana da UAS7PQ foi maior nos pacientes do Grupo 1 &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; enquanto a mediana da UAS7QP foi semelhante entre os pacientes do Grupo 2 e os do Grupo 3 &#40;p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#59; <a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Nos tr&#234;s grupos&#44; a mediana da UAS7QP foi maior que a mediana da UAS7AP&#44; e esse aumento foi estatisticamente significativo nos pacientes do Grupo 1 &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e naqueles do Grupo 3 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;008&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Os escores da FC&#8208;19s e DASS&#8208;21 n&#227;o diferiram entre os tr&#234;s grupos no PQ &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">No RTPN&#44; observou&#8208;se que todos os pacientes do Grupo 1 reiniciaram o omalizumabe devido &#224; piora dos sintomas&#46; As medianas dos escores da UAS7&#44; FC&#8208;19s e DASS&#8208;21 n&#227;o foram diferentes entre os tr&#234;s grupos no RTPN &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Escores na FC&#8208;19s em pacientes com aumento da atividade da urtic&#225;ria durante o PQ</span><p id="par0130" class="elsevierStylePara elsevierViewall">Trinta e quatro &#40;32&#44;7&#37;&#41; pacientes apresentaram aumento da atividade da urtic&#225;ria durante o PQ&#46; Entre esses pacientes&#44; os escores da FC&#8208;19s durante o PQ e ter comorbidades associadas a COVID&#8208;19 mais grave foram estatisticamente maiores do que naqueles com atividade de urtic&#225;ria est&#225;vel &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;013 e p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#44; respectivamente&#41;&#46; Um total de 22&#44;4&#37; dos pacientes do Grupo 3 tiveram aumento da atividade da urtic&#225;ria durante o PQ&#44; e esses pacientes apresentaram escores de FC&#8208;19s mais altos em compara&#231;&#227;o com aqueles com atividade de doen&#231;a est&#225;vel &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;008&#41;&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discuss&#227;o</span><p id="par0135" class="elsevierStylePara elsevierViewall">Este &#233; o primeiro estudo que investiga o impacto da pandemia de COVID&#8208;19 em pacientes com UCE refrat&#225;ria tratados com omalizumabe&#46; Os achados do presente estudo revelaram que a pandemia de COVID&#8208;19 pode prejudicar o curso da UCE refrat&#225;ria e as interven&#231;&#245;es para apoiar os tratamentos em andamento s&#227;o&#44; portanto&#44; cruciais&#46; Al&#233;m disso&#44; ele fornece contribui&#231;&#227;o adicional &#224;s recomenda&#231;&#245;es da recente declara&#231;&#227;o da European Academy of Allergy and Clinical Immunology &#40;EAACI&#41; sobre tratamento com biol&#243;gicos na UCE durante a pandemia&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> mostrando que at&#233; oito semanas de intervalo entre inje&#231;&#245;es subsequentes de omalizumabe podem ser toleradas na UCE refrat&#225;ria durante a pandemia&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Os pacientes com UCE apresentam n&#237;veis mais altos de estresse&#44; e a atividade da doen&#231;a est&#225; correlacionada com os n&#237;veis de estresse emocional&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">18&#44;19</span></a> Estudo recente avaliou o impacto da pandemia em 509 pacientes com UCE leve&#47;moderada e revelou aumento da atividade da urtic&#225;ria e n&#237;veis mais altos de estresse durante o PQ em compara&#231;&#227;o com AP e RTPN&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> No presente estudo foi poss&#237;vel determinar o aumento da atividade da doen&#231;a em pacientes com UCE refrat&#225;ria que receberam omalizumabe durante a pandemia&#46; Como os dist&#250;rbios emocionais e os eventos estressantes da vida influenciam o curso da UCE&#44; pode&#8208;se especular que a pandemia de COVID&#8208;19 teria efeitos prejudiciais nos pacientes com UCE&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">O medo &#233; uma das caracter&#237;sticas das doen&#231;as infecciosas&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> Com a alta taxa de infec&#231;&#227;o e mortalidade relativamente alta&#44; os indiv&#237;duos podem se preocupar com a COVID&#8208;19&#46; A esse respeito&#44; utilizou&#8208;se a escala FC&#8208;19s&#44; que &#233; ferramenta v&#225;lida para avaliar o medo da COVID&#8208;19 e est&#225; correlacionada significativamente com depress&#227;o e ansiedade&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> Shin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> tamb&#233;m afirmaram que o neurocircuito do medo&#47;ansiedade tem sobreposi&#231;&#227;o e intera&#231;&#227;o com o neurocircuito que orquestra a resposta ao estresse&#46; No presente estudo&#44; os escores da FC&#8208;19s foram significativamente maiores durante o PQ em compara&#231;&#227;o ao RTPN&#44; e os escores da FC&#8208;19s foram correlacionados com os escores da escala DASS&#8208;21&#46; Al&#233;m disso&#44; entre os pacientes que continuaram o tratamento com omalizumabe&#44; aqueles que apresentaram aumento da atividade da urtic&#225;ria apresentaram escores mais altos de FC&#8208;19s no PQ&#44; indicando o impacto do medo no curso da UCE&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">A resposta a um fator de estresse psicossocial &#233; diferente entre os sexos&#46; A redu&#231;&#227;o do condicionamento do medo &#233; observada em homens estressados&#44; enquanto as mulheres estressadas podem mostrar reconhecimento aumentado do medo&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">23&#44;24</span></a> Essa pode ser a prov&#225;vel explica&#231;&#227;o para o fato de as pacientes do sexo feminino apresentarem escores de FC&#8208;19s mais altos&#44; enquanto os escores na escala DASS&#8208;21 n&#227;o foram diferentes dos observados nos homens&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">As medidas de conten&#231;&#227;o&#44; como redu&#231;&#227;o de visitas a hospitais e isolamento domiciliar implementadas para evitar a propaga&#231;&#227;o dessa doen&#231;a altamente contagiosa&#44; tornaram&#8208;se obst&#225;culo para o seguimento e tratamento de doen&#231;as cr&#244;nicas&#46; De maneira similar&#44; Kocat&#252;rk et al&#46; afirmaram que o n&#250;mero semanal de pacientes de urtic&#225;ria cr&#244;nica &#40;UC&#41; tratados nos centros UCARE diminuiu mais de 50&#37; durante a pandemia de COVID&#8208;19&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Estudo avaliando os efeitos da pandemia em pacientes com UC revelou 44&#37; de interrup&#231;&#227;o do tratamento com omalizumabe&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> No presente estudo&#44; 81&#44;7&#37; dos pacientes continuaram com omalizumabe&#46; Essa taxa de ades&#227;o relativamente mais alta pode ser atribu&#237;da aos regulamentos nas cl&#237;nicas do presente estudo para a continua&#231;&#227;o dos tratamentos em andamento com omalizumabe durante a pandemia&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">O omalizumabe s&#243; pode ser injetado em hospitais mediante receita m&#233;dica na Turquia&#46; Durante o PQ&#44; o MST facilitou o acesso &#224; medica&#231;&#227;o prescrita para aqueles que tinham relat&#243;rios de consentimento de prescri&#231;&#227;o v&#225;lidos&#46; Pela facilita&#231;&#227;o do acesso &#224; medica&#231;&#227;o prescrita&#44; 20&#37; dos pacientes do presente estudo continuaram suas inje&#231;&#245;es em diferentes centros al&#233;m do centro de sa&#250;de inicial&#44; enquanto 2&#44;4&#37; dos pacientes fizeram terapia domiciliar&#46; Nesse ponto&#44; deve&#8208;se enfatizar a import&#226;ncia da aten&#231;&#227;o espec&#237;fica para interven&#231;&#245;es personalizadas em rela&#231;&#227;o a medicamentos utilizados em doen&#231;as cr&#244;nicas durante per&#237;odos especiais&#44; como surtos de doen&#231;as&#44; a fim de manter o acompanhamento e o tratamento efetivos&#46; Em estudo recente de &#214;zt&#252;rk et al&#46;&#44; eles afirmaram que 59&#37; dos alergistas de adultos&#47;pedi&#225;tricos na Turquia utilizavam a telemedicina para o tratamento de pacientes com urtic&#225;ria&#47;angioedema&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">A recente declara&#231;&#227;o da EAACI sobre o uso de produtos biol&#243;gicos durante a COVID&#8208;19 aconselhou a n&#227;o alterar a terapia em indiv&#237;duos n&#227;o infectados com base na opini&#227;o de especialistas&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> Entretanto&#44; ajustes bem&#8208;sucedidos no tratamento com omalizumabe foram demonstrados em pacientes com UCE refrat&#225;ria antes da pandemia&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">28&#8211;30</span></a> No presente estudo&#44; foi demonstrado pela primeira vez que os ajustes de intervalo entre doses podem ser tolerados em pacientes com UCE refrat&#225;ria durante a pandemia&#44; mas a interrup&#231;&#227;o pode piorar o curso da doen&#231;a&#46; Os pacientes com intervalos prolongados entre doses de omalizumabe apresentaram escores mais altos na UAS7AP&#46; Portanto&#44; o prolongamento do intervalo pode ser recomendado para pacientes com bom controle da urtic&#225;ria&#44; a fim de reduzir as visitas hospitalares durante a pandemia&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Por outro lado&#44; 78&#44;9&#37; dos pacientes que interromperam o uso de omalizumabe apresentaram aumento da atividade da urtic&#225;ria&#46; Como os pacientes do presente estudo tinham UCE refrat&#225;ria&#44; era esperada a perda do controle da doen&#231;a quando o omalizumabe foi interrompido&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">A COVID&#8208;19 tem sido um risco para todos os seres humanos&#44; e comorbidades como diabetes <span class="elsevierStyleItalic">mellitus</span>&#44; hipertens&#227;o&#44; doen&#231;as cardiovasculares e doen&#231;as respirat&#243;rias cr&#244;nicas foram identificadas como fatores de risco para COVID&#8208;19 grave&#46; No presente estudo&#44; os pacientes com essas comorbidades apresentaram maiores escores nas escalas UAS7&#44; DASS&#8208;21&#44; FC&#8208;19s&#44; mas n&#227;o foram estatisticamente significativos&#46; Apesar disso&#44; 47&#44;1&#37; deles tiveram aumento de atividade da urtic&#225;ria durante o PQ&#44; e isso &#233; estatisticamente significativo quando comparados aos pacientes sem comorbidades&#46; Pode&#8208;se especular que o conhecimento de ter comorbidades que s&#227;o associadas &#224; infec&#231;&#227;o grave por COVID&#8208;19 resultou na perda do controle da doen&#231;a&#44; o que pode ser outro indicador da associa&#231;&#227;o de medo e estresse com atividade de urtic&#225;ria&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Houve duas limita&#231;&#245;es no presente estudo&#46; A primeira &#233; o pequeno tamanho da amostra de pacientes com intervalos prolongados entre doses de omalizumabe&#44; o que pode ter afetado a acur&#225;cia dos resultados estat&#237;sticos&#46; Recomenda&#8208;se aos pacientes que n&#227;o alterem a terapia&#44; de acordo com a declara&#231;&#227;o da EAACI&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> Os pacientes do Grupo 2 prolongaram os intervalos independentemente das sugest&#245;es m&#233;dicas&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Como segunda limita&#231;&#227;o&#44; n&#227;o foi poss&#237;vel avaliar a sa&#250;de mental dos pacientes com as mesmas ferramentas anteriores ao estudo&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclus&#227;o</span><p id="par0195" class="elsevierStylePara elsevierViewall">Foi observado que tanto o medo quanto o estresse induzidos pela COVID&#8208;19 e a interrup&#231;&#227;o do tratamento com omalizumabe produziram aumento na atividade da urtic&#225;ria&#46; Portanto&#44; os pacientes recebendo omalizumabe devem continuar seu tratamento com os mesmos intervalos de dose ou intervalos prolongados&#59; interven&#231;&#245;es personalizadas&#44; como telemedicina e terapia domiciliar&#44; devem ser consideradas para pacientes com doen&#231;as cr&#244;nicas durante per&#237;odos de surtos de doen&#231;as&#44; a fim de manter acompanhamento eficaz e reduzir visitas desnecess&#225;rias aos hospitais&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Suporte financeiro</span><p id="par0200" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Contribui&#231;&#227;o dos autores</span><p id="par0205" class="elsevierStylePara elsevierViewall">M&#252;ge Olga&#231;&#58; Fez contribui&#231;&#245;es substanciais para concep&#231;&#227;o e planejamento&#44; obten&#231;&#227;o dos dados&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participou na reda&#231;&#227;o do manuscrito&#44; e revis&#227;o cr&#237;tica do conte&#250;do intelectual importante&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Osman Ozan Ye&#287;it&#58; Fez contribui&#231;&#245;es substanciais na obten&#231;&#227;o de dados&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participou na reda&#231;&#227;o do manuscrito&#44; e revis&#227;o cr&#237;tica do conte&#250;do intelectual importante&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Sengul Beyaz&#58; Fez contribui&#231;&#245;es substanciais para a obten&#231;&#227;o dos dados&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participou da reda&#231;&#227;o do manuscrito&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">&#214;zdemir Can T&#252;zer&#58; Fez contribui&#231;&#245;es substanciais para a obten&#231;&#227;o dos dados&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participou da reda&#231;&#227;o do manuscrito&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Deniz Eyice Karabacak&#58; Fez contribui&#231;&#245;es substanciais para a concep&#231;&#227;o e planejamento&#44; obten&#231;&#227;o dos dados&#44; participou na reda&#231;&#227;o do manuscrito&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Nida Oztop&#58; Fez contribui&#231;&#245;es substanciais para a obten&#231;&#227;o dos dados&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participou da reda&#231;&#227;o do manuscrito&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Pelin Karada&#287;&#58; Fez contribui&#231;&#245;es substanciais para a obten&#231;&#227;o dos dados&#44; interpreta&#231;&#227;o dos dados&#59; participou da reda&#231;&#227;o do manuscrito&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Raif Co&#351;kun&#58; Fez contribui&#231;&#245;es substanciais para concep&#231;&#227;o e planejamento&#44; obten&#231;&#227;o dos dados ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participou da reda&#231;&#227;o do manuscrito&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Semra Demir&#58; Fez contribui&#231;&#245;es substanciais para concep&#231;&#227;o e planejamento&#44; obten&#231;&#227;o dos dados&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participou na reda&#231;&#227;o do manuscrito e na revis&#227;o cr&#237;tica do conte&#250;do intelectual importante&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">Bahauddin Colakoglu&#58; Fez contribui&#231;&#245;es substanciais para concep&#231;&#227;o e planejamento&#44; obten&#231;&#227;o dos dados&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participou na reda&#231;&#227;o do manuscrito ou na revis&#227;o cr&#237;tica do conte&#250;do intelectual importante&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">Suna Buyukozturk&#58; Fez contribui&#231;&#245;es substanciais para concep&#231;&#227;o e planejamento&#44; aquisi&#231;&#227;o dos dados&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participou na revis&#227;o cr&#237;tica do manuscrito para conte&#250;do intelectual importante&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Asl&#305; Gelincik&#58; Fez contribui&#231;&#245;es substanciais para concep&#231;&#227;o e planejamento&#44; aquisi&#231;&#227;o dos dados&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participou na revis&#227;o cr&#237;tica do manuscrito para o conte&#250;do intelectual importante&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflito de interesses</span><p id="par0265" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">O curso da urtic&#225;ria cr&#244;nica espont&#226;nea &#40;UCE&#41; pode ser influenciado por infec&#231;&#245;es&#44; depress&#227;o e estresse&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">O objetivo do estudo foi investigar o impacto da pandemia de COVID&#8208;19 no curso da UCE refrat&#225;ria&#44; juntamente com a ades&#227;o dos pacientes ao omalizumabe e ajustes no tratamento&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A escala <span class="elsevierStyleItalic">Urtic&#225;ria Activity Score</span> &#40;UAS7&#41; foi utilizada para avaliar a atividade da doen&#231;a&#46; As escalas <span class="elsevierStyleItalic">Fear of COVID&#8208;19</span> &#40;FC&#8208;19s&#41; e <span class="elsevierStyleItalic">Depression Anxiety Stress Scale</span> &#40;DASS&#8208;21&#41; foram utilizadas para avaliar o estado de sa&#250;de mental&#46; Todas as escalas foram utilizadas durante o per&#237;odo de quarentena &#40;PQ&#41; e retorno ao per&#237;odo normal &#40;RTPN&#41;&#46; A escala UAS7 antes da pandemia &#40;AP&#41; foi registrada a partir dos prontu&#225;rios dos pacientes&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Foram avaliados 104 pacientes com UCE recebendo omalizumabe&#46; Os escores da UAS7 durante o PQ foram significativamente maiores do que os do RTPN e AP &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; Os escores da DASS&#8208;21 e FC&#8208;19 foram significativamente maiores durante o PQ em compara&#231;&#227;o ao RTPN &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; Dezenove &#40;18&#44;2&#37;&#41; pacientes interromperam o tratamento com omalizumabe&#44; e nove pacientes prolongaram os intervalos entre as doses subsequentes durante a pandemia&#46; Os escores da UAS7 no PQ foram significativamente maiores nos pacientes que interromperam o tratamento com omalizumabe do que naqueles que continuaram &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Entre os pacientes que continuaram o tratamento com omalizumabe&#44; 22&#44;4&#37; tiveram aumento da atividade da urtic&#225;ria e maiores escores na escala FC&#8208;19 em compara&#231;&#227;o com aqueles com atividade de doen&#231;a est&#225;vel &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;008&#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 tamanho da amostra de pacientes com intervalos prolongados de omalizumabe e a falta de avalia&#231;&#227;o da sa&#250;de mental com os mesmos instrumentos anteriores ao estudo&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">O medo induzido pela COVID&#8208;19 pode gerar aumento na atividade da doen&#231;a&#46; Portanto&#44; os pacientes em uso de omalizumabe devem continuar seu tratamento&#44; e intervalos prolongados sem omalizumabe podem ser considerados em pacientes com bom controle da urtic&#225;ria&#46;</p></span>"
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          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Correla&#231;&#227;o dos escores da DASS&#8208;21 e UAS7 no PQ&#46; &#40;B&#41; Correla&#231;&#227;o dos escores da DASS&#8208;21 e UAS7 no RTPN&#46; DASS&#8208;21&#44; <span class="elsevierStyleItalic">Depression Anxiety and Stress Scale</span>&#59; UAS&#8208;7&#44; Seven days urticaria activity score&#59; PQ&#44; per&#237;odo de quarentena&#59; RTPN&#44; retorno ao per&#237;odo normal&#46;</p>"
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        "etiqueta" => "Figura 6"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Correla&#231;&#227;o dos escores da DASS&#8208;21 e FC&#8208;19s no PQ&#46; &#40;B&#41; Correla&#231;&#227;o dos escores da DASS&#8208;21 e FC&#8208;19s no RTPN&#46; DASS&#8208;21&#44; <span class="elsevierStyleItalic">Depression Anxiety and Stress Scale</span>&#59; FC&#8208;19s&#44; <span class="elsevierStyleItalic">Fear of COVID&#8208;19 scale&#59;</span> PQ&#44; per&#237;odo de quarentena&#59; RTPN&#44; retorno ao per&#237;odo normal&#46;</p>"
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        "tipo" => "MULTIMEDIATABLA"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Idade&#44;</span> m&#233;dia anos<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">42&#44;74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Sexo&#44; n &#40;&#37;&#41;</span></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">77 &#40;74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Doen&#231;a concomitante&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46 &#40;44&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Doen&#231;as cardiovasculares&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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 &#40;3&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Doen&#231;as respirat&#243;rias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;9&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Doen&#231;as da tireoide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;9&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipertens&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;9&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Arritmia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diabetes <span class="elsevierStyleItalic">mellitus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;12&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hiperlipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;5&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Outras&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;7&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Dura&#231;&#227;o da urtic&#225;ria&#44; anos&#44; mediana &#40;IIQ 25</span>&#8208;<span class="elsevierStyleBold">75&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;3&#8208;8&#44;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Dura&#231;&#227;o do uso de omalizumabe&#44; meses&#44; mediana &#40;IIQ 25</span>&#8208;<span class="elsevierStyleBold">75&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;14&#8208;36&#44;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Presen&#231;a de angioedema&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66 &#40;63&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Presen&#231;a de urtic&#225;ria induzida&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;48&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urtic&#225;ria ao frio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;12&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urtic&#225;ria solar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;29&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urtic&#225;ria aquag&#234;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urtic&#225;ria de press&#227;o tardia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;17&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urtic&#225;ria vibrat&#243;ria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urtic&#225;ria colin&#233;rgica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;12&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urtic&#225;ria de contato&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dermografismo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;22&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Presen&#231;a de fatores desencadeantes&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68 &#40;65&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Medicamentos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;21&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alimentos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;29&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estresse&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;51&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grupo 3 &#40;76 pacientes&#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" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " rowspan="3" align="left" valign="\n
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                  \t\t\t\t">UAS&#8208;7 mediana &#40;IIQ&#58; 25&#8208;75&#41;</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">AP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#8208;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#8208;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;021&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">PQ&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">28 &#40;12&#8208;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#8208;6&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;0&#8208;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RTPN&nbsp;\t\t\t\t\t\t\n
                  \t\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 &#40;0&#8208;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;0&#8208;21&#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">4 &#40;0&#8208;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
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                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">FC&#8208;19s &#40;m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&#41;</td><td class="td" title="\n
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                  \t\t\t\t">PQ&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">19&#44;42<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;69&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&#44;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;29&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">17&#44;99<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;4&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">NS&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">RTPN&nbsp;\t\t\t\t\t\t\n
                  \t\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">16&#44;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;12&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14&#44;78<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;44&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16&#44;64<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">DASS&#8208;21s mediana &#40;IIQ&#58; 25&#8208;75&#41;</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">PQ&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;0&#44;5&#8208;12&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;5&#40;1&#8208;14&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  """
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Escores de UAS7&#44; DASS&#8208;21s&#44; e FC&#8208;19s de tr&#234;s grupos de pacientes AP&#44; no PQ e no RTPN</p>"
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                0 => array:2 [
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                      "titulo" => "The EAACI&#47;GA<span class="elsevierStyleSup">2</span>LEN&#47;EDF&#47;WAO guideline for the definition&#44; classification&#44; diagnosis and management of urticaria"
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                        0 => array:2 [
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                0 => array:1 [
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ISSN: 26662752
Idioma original: Português
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