Epidermólise bolhosa hereditária: perfil clínico‐epidemiológico de 278 pacientes em hospital terciário em São Paulo, Brasil | Anais Brasileiros de Dermatologia (Portuguese)

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(A) Defeitos no esmalte dentário na arcada dentária inferior, com depressões puntiformes e coloração amarelada. Na arcada dentária superior é possível observar facetas laminadas (lentes de contato dentárias). (B) Fragilidade cutânea, áreas sem epitelização, outras áreas com tecido de granulação e crostas, no bebê." ] ] ] "textoCompleto" => "IntroduçãoEpidermólise bolhosa (EB) é um grupo de doenças hereditárias raras, até o momento incuráveis, geneticamente determinadas, caracterizadas por fragilidade da pele e mucosas. Há formação de bolhas mucocutâneas, erosões e ulcerações a pequenos traumas, o que causa impacto na qualidade de vida dos indivíduos acometidos.<a class="elsevierStyleCrossRef" href="#bib0205">1</a>O consenso para classificação das EB de 2020<a class="elsevierStyleCrossRef" href="#bib0205">1</a> separou as formas clássicas de EB de outras doenças que cursam com fragilidade cutânea, em que a clivagem na pele é muito superficial (suprabasal), como síndrome da pele decídua.<a class="elsevierStyleCrossRef" href="#bib0205">1</a> Nas formas clássicas de EB, o quadro clínico é heterogêneo. De acordo com o plano de clivagem na pele, as EB são divididas em quatro tipos principais: EB simples (EBS), EB juncional (EBJ), EB Ddistrófica (EBD) e EB Kindler (EBK).<a class="elsevierStyleCrossRef" href="#bib0205">1</a> Mais de 30 subtipos clínicos são reconhecidos e foram descritas mutações patogênicas em 21 genes distintos, que codificam proteínas envolvidas na adesão e integridade celulares.<a class="elsevierStyleCrossRef" href="#bib0210">2</a>Dados epidemiológicos no Brasil sobre EB são escassos.<a class="elsevierStyleCrossRefs" href="#bib0215">3,4</a> A associação DEBRA Brasil tem registro de 1.027 pacientes no país; entretanto, esse dado não está publicado. Os estudos brasileiros publicados são relatos e séries de casos com caracterização clínica e alguns com análise genética.<a class="elsevierStyleCrossRefs" href="#bib0215">3–13</a>Em doenças raras, dados epidemiológicos confiáveis, com base em coortes bem caracterizadas, são essenciais.<a class="elsevierStyleCrossRef" href="#bib0270">14</a> Ressaltam a necessidade de atenção ao cuidado e aos custos para os sistemas de saúde de um país específico. Também são importantes para o desenvolvimento e execução de estudos clínicos e para estimar o número de pacientes que poderiam se beneficiar com determinado tratamento.<a class="elsevierStyleCrossRef" href="#bib0275">15</a> Estudos clínicos de fase 3 com Beremagene Geperpavec (B‐VEC) em pacientes com EBD mostraram resultados promissores quanto à cicatrização de feridas. Trata‐se de terapia tópica genética associada à edição gênica, com sequências de COL7A1 encapsuladas em vetores virais de herpes simples tipo 1.<a class="elsevierStyleCrossRef" href="#bib0280">16</a>O objetivo desse estudo foi descrever os achados clínicos e epidemiológicos da EB hereditária de um hospital terciário em São Paulo, Brasil.MétodosEstudo observacional, retrospectivo e transversal foi conduzido, após aprovação do Comitê de Ética da instituição, por meio da análise de prontuários físicos e eletrônicos de 309 pacientes diagnosticados com EB, na Divisão de Dermatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC‐FMUSP), Brasil, de 1 de janeiro de 2000 a 31 de dezembro de 2022.O diagnóstico foi baseado na apresentação clínica, história familiar, comorbidades e nos exames histológico e de imunomapeamento obtidos por meio de material de biopsia de pele. Os diagnósticos foram agrupados nas seguintes categorias: EBS, EBJ, EBD dominante (EBDD), EBD recessiva (EBDR), EBD pruriginosa e EBK. Pacientes com dados incompletos ou prontuários médicos indisponíveis foram excluídos, assim como as doenças com clivagem suprabasal (consenso de 2020).<a class="elsevierStyleCrossRef" href="#bib0205">1</a> Indivíduos com a doença e familiares também acometidos que não estavam registrados no nosso serviço não foram ativamente recrutados.O banco de dados utilizado nesse estudo incluiu forma clínica de EB, sexo, história familiar de EB, presença de consanguinidade, idade de diagnóstico, idade atual, tempo de seguimento, comorbidades, realização de exame histológico e de imunomapeamento, presença de nevos EB e de tumores cutâneos, causa e idade de morte (se aplicável). Teste genético não foi incluído, pois não é ainda rotineiramente disponível no serviço. Dados estatísticos foram apresentados como porcentagens e médias.ResultadosNo total, dos 309 pacientes com EB, 31 foram excluídos, devido a dados incompletos. No total de 278 pacientes incluídos, 147 (53%) eram mulheres e 131 (47%), homens. O tipo mais comum foi a forma distrófica, com 203 pacientes (73%), dentre os quais 79 (28,4%) são EBDD (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1A</a>), 36 (12,9%) são EBD pruriginosa (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1B</a>) e 88 (31,7%) são EBDR (<a class="elsevierStyleCrossRef" href="#fig0010">fig. 2</a>). Outros tipos foram EBJ (<a class="elsevierStyleCrossRef" href="#fig0015">fig. 3</a>) com 26 (9,4%) pacientes, EBS (<a class="elsevierStyleCrossRef" href="#fig0020">fig. 4</a>) com 46 (16,5%) e tipo Kindler (<a class="elsevierStyleCrossRef" href="#fig0025">fig. 5</a>) em 3 (1,1%). História familiar positiva foi encontrada em 96 (35%) pacientes. Relato de consanguinidade esteve presente em 31 (11%) pacientes. A distribuição dos pacientes pelo tipo de EB em relação ao sexo, ao histórico familiar e à consanguinidade pode ser observada na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia>A média de idade ao diagnóstico foi de 10,8 anos (variou de 1 dia de vida até 82 anos, conforme detalhado na <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>). Noventa e três (33,5%) pacientes foram diagnosticados com menos de 1 ano de vida, enquanto 103 (37%) tinham entre 1 e 10 anos. Entre 11 e 20 anos de idade, 29 (10%) pacientes foram diagnosticados. Entre 21 e 80 anos, 52 (19%) pacientes obtiveram diagnóstico de EB, enquanto somente um paciente masculino tinha 82 anos.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Em relação à idade atual (<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>), a média foi de 26 anos. Para o cálculo, a idade considerada no caso dos pacientes que foram à óbito foi a idade da morte. Somente 40 (14%) indivíduos tinham menos de 10 anos, enquanto 92 (33%) pacientes tinham entre 11 e 20 anos. Na faixa etária entre 21 e 80 anos, havia 143 (51%) pacientes, enquanto três tinham mais de 81 anos.A média do tempo de seguimento foi de 9 anos, excluídos seis pacientes que compareceram somente para exame diagnóstico e não compareceram para seguimento no ambulatório. Para os pacientes falecidos, foi considerada a data da última consulta antes de o óbito acontecer.Em relação ao comprometimento extracutâneo (<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>), 40 (14%) pacientes tiveram diferentes graus de disfagia (estenose de esôfago). Desses, 25 (62,5%) são EBDR, 10 (25%) são EBDD, dois (5%) são EBD pruriginosa, dois (5%) são EBJ, um (2,5%) é EBS e nenhum é EBK.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Doenças dentárias foram identificadas em 100 (36%) pacientes, dentre os quais 54 (54%) são EBDR, 28 (28%) são EBDD, 13 (13%) são EBS, três (3%) são EBJ, dois (2%) são EBK e nenhum é EBD pruriginosa.Desnutrição foi avaliada por meio do índice de massa corporal (IMC ≤ 18) e acometeu 35 (13%) indivíduos. Desses, 24 (68,6%) são EBDR, seis (17,1%) são EBDD, três (8,5%) são EBS, um (2,9%) é EBJ e um (2,9%) é EBK.Anemia foi achado frequente, com 81 (29%) pacientes acometidos; seis (2%) deles foram submetidos a transfusões sanguíneas, todos EBDR.Acometimento ortopédico foi observado em 67 (24%) pacientes e aqueles com pseudosindactilia nas mãos (59 pacientes) foram encaminhados ao ambulatório de ortopedia.Nevos da epidermólise bolhosa (nevos EB) foram identificados em 47 (17%) indivíduos, no total de 90 nevos, uma vez que um mesmo paciente apresentou de uma a cinco lesões (<a class="elsevierStyleCrossRef" href="#fig0030">fig. 6A</a>). Dez pacientes eram EBDD, 29 eram EBDR, dois eram EBJ, cinco eram EBS e um era EBD pruriginosa.<elsevierMultimedia ident="fig0030"></elsevierMultimedia>Atresia de piloro foi identificada em uma paciente EBS com acometimento cutâneo grave. Distrofia muscular foi observada em um paciente EBS. Cardiomiopatia dilatada foi identificada em um paciente EBK de 30 anos que perdeu seguimento e em um paciente EBDR, que foi a óbito aos 20 anos.Alterações dermatológicas não relacionadas à EB incluem dermatite seborreica (1), dermatite atópica (1), pseudotínea amiantácea (1). Foliculite decalvante foi identificada em dois indivíduos, ambos com a forma distrófica de EB. Alopecia cicatricial acometeu duas pacientes EBJ. A <a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a> mostra outras doenças extracutâneas encontradas nos pacientes dessa coorte.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>No processo de investigação diagnóstica, 202 (72,6%) indivíduos foram submetidos ao total de 302 biopsias para exame histológico. Imunomapeamento foi realizado em 256 (92%) pacientes, com total de 359 exames realizados nesse período. Nove realizaram somente biopsia, 63 realizaram somente imunomapeamento, 193 pacientes foram submetidos a ambos os exames e 13 não fizeram nenhum. A classificação do tipo de EB dos 13 pacientes que não realizaram nenhum exame levou em consideração história familiar e quadro clínico compatível, apesar de o diagnóstico não ter sido confirmado laboratorialmente. Esses pacientes não foram submetidos à biopsia de pele ou imunomapeamento por questões sociais (indisponibilidade de retornar ao hospital) ou por falta de consentimento dos responsáveis ou dos próprios pacientes (cinco recém‐natos, cinco crianças menores de 12 anos e três adultos, idades 17, 27 e 49 anos).Durante o período de seguimento, nove (3,2%) pacientes foram diagnosticados com 11 carcinomas espinocelulares (CEC). Um paciente EBJ apresentou três CEC (um em cada membro inferior e um no dorso). A localização do CEC (<a class="elsevierStyleCrossRef" href="#fig0030">fig. 6B</a>) nos demais pacientes foi nos membros inferiores em seis (um EBJ, quatro EBDR e um EBDD) e dorso em um paciente (EBDR). Em uma das pacientes EBDR, o local do CEC é desconhecido, por falta de informação nos registros médicos. Amputação transtibial foi realizada em três pacientes (dois homens EBDR aos 18 e aos 19 anos e uma mulher EBDD aos 27 anos). Cinco (55,5%) apresentaram metástase e foram a óbito, dentre os quais três EBDR (a idade do óbito de dois foi aos 18 anos e de um foi aos 20 anos), um EBDD (28 anos) e um EBJ (57 anos).No total, 11 pacientes foram a óbito, cinco EBDR (18, 18, 20, 22 e 24 anos), cinco EBDD (1, 11, 15, 15, 28 anos) e um EBJ (57 anos). Causa de morte de cinco destes foi por complicações de CEC metastático. Três foram a óbito em virtude de sepse por broncopneumonia (dois EBDD, ambos com 15 anos, e um EBDR de 22 anos). Um paciente EBDR de 24 anos teve broncoaspiração como causa de morte. Duas crianças EBDD, de 1 ano e de 11 anos, foram a óbito sem causa conhecida.Pacientes que não compareceram a consultas na dermatologia e em outras especialidades no HC‐FMUSP há mais de dois anos foram considerados perda de seguimento. No total, 158 (57%) pacientes tiveram data da última consulta antes de 31/12/2020. Entre 2021 e 2022, três pacientes foram a óbito.DiscussãoEm nosso estudo de EB hereditária, não observamos predileção por sexo; o número de mulheres e homens acometidos foi semelhante, conforme previamente descrito na literatura.<a class="elsevierStyleCrossRefs" href="#bib0210">2,17</a> A forma distrófica de EB foi a mais frequente (73,4%), proporção semelhante à encontrada em estudo realizado no Irã (75,7%).<a class="elsevierStyleCrossRef" href="#bib0285">17</a> Estudos de outros países descreveram frequência menor de EBD, como Canadá (35%),<a class="elsevierStyleCrossRef" href="#bib0290">18</a> Austrália (35%),<a class="elsevierStyleCrossRef" href="#bib0295">19</a> Holanda<a class="elsevierStyleCrossRef" href="#bib0300">20</a> com 34,7% (EBDD 23,1% e EBDR 11,4%), Alemanha (32,5%)<a class="elsevierStyleCrossRef" href="#bib0305">21</a> e Índia (17%).<a class="elsevierStyleCrossRef" href="#bib0310">22</a> A predominância de formas mais graves de EB em nosso estudo se deve, em parte, a dificuldades de acesso a atendimento médico especializado<a class="elsevierStyleCrossRef" href="#bib0315">23</a> em nosso país e subdiagnóstico das formas mais localizadas de EBS e ao fato de o HC‐FMUSP ser hospital terciário, referência nacional no atendimento de paciente com EB, e atender casos de mais alta complexidade.No presente estudo, EBS acometeu 16,5% dos pacientes, enquanto EBJ 9,4% dos pacientes e EBK 1,1%. A frequência de EBJ no estudo do Irã,<a class="elsevierStyleCrossRef" href="#bib0285">17</a> Canadá<a class="elsevierStyleCrossRef" href="#bib0290">18</a> e Austrália<a class="elsevierStyleCrossRef" href="#bib0295">19</a> foi de 11%; na Holanda<a class="elsevierStyleCrossRef" href="#bib0300">20</a> de 18,8% e na Alemanha,<a class="elsevierStyleCrossRef" href="#bib0305">21</a> 17,1%. Já EBK, 3% no Irã,<a class="elsevierStyleCrossRef" href="#bib0285">17</a> 0,3% na Austrália,<a class="elsevierStyleCrossRef" href="#bib0295">19</a> 0,9% na Holanda<a class="elsevierStyleCrossRef" href="#bib0300">20</a> e 0,5% na Alemanha.<a class="elsevierStyleCrossRef" href="#bib0305">21</a> Em ambos os tipos de EB, as porcentagens encontradas em nosso estudo foram semelhantes. Em relação à EBS, a frequência encontrada é menor do que a descrita na literatura, uma vez que a população estudada advém de hospital terciário. Segundo estudo epidemiológico de 2021da Holanda,<a class="elsevierStyleCrossRef" href="#bib0300">20</a> EBS foi diagnosticada em 45,7%. Nessa coorte holandesa, 90,5% dos pacientes tiveram diagnóstico geneticamente confirmado.<a class="elsevierStyleCrossRef" href="#bib0300">20</a> Dados epidemiológicos de 1.779 pacientes da Alemanha, publicados em 2022,<a class="elsevierStyleCrossRef" href="#bib0305">21</a> mostraram 39,3% (700) de pacientes EBS. Este estudo incluiu pacientes de hospitais terciários, ambulatórios de Dermatologia, laboratórios que realizaram o diagnóstico e de organizações de pacientes.A média da idade atual encontrada em nosso estudo foi de 26 anos, e somente 40 (14%) indivíduos tinham menos de 10 anos. O elevado número de pacientes na idade puberal, ou seja, acima de 11 anos, permite inferir aumento na expectativa de vida e reflete a melhora nos cuidados multidisciplinares, principalmente em relação à nutrição, infecção e manejo da dor.Quanto à consanguinidade, apenas 31 pacientes (11%) declararam sua ocorrênci, e a EBDR foi o tipo que mais acometeu a população em estudo (25,8%). Como a maioria dos pacientes não realizou teste genético, o diagnóstico não foi confirmado por esse método. Na literatura, é relatado que o número de pacientes com forma autossômica recessiva de EB pode estar associado às comunidades com altas taxas de consanguinidade parental.<a class="elsevierStyleCrossRef" href="#bib0320">24</a>As queixas mais comuns dos pacientes foram alterações dentárias (36%), seguido por anemia (29%) e doenças ortopédicas (24%). No estudo do Irã, foi disfagia seguido de alterações dentárias.<a class="elsevierStyleCrossRef" href="#bib0285">17</a> Esses achados dentários se devem na EBJ à hipoplasia do esmalte dentário e presença de depressões puntiformes (<a class="elsevierStyleCrossRef" href="#fig0015">fig. 3A</a>), que são achados clínicos patognomônicos nessa forma de EB. Essas alterações acarretam perda precoce de dentes e cáries. Na EBDR, microstomia e anquiloglossia são observadas e dificultam a higiene dental diária.<a class="elsevierStyleCrossRef" href="#bib0325">25</a> Deve‐se sempre levar em consideração os cuidados precários de higiene bucal na maioria dos doentes com EB (<a class="elsevierStyleCrossRef" href="#fig0025">fig. 5B</a>).Pseudosindactilia das mãos (<a class="elsevierStyleCrossRef" href="#fig0010">fig. 2B</a>) e dos pés é complicação músculo‐esquelética que ocorre principalmente na EBDR.<a class="elsevierStyleCrossRef" href="#bib0325">25</a> O uso de luvas ou curativos para manter os quirodáctilos separados é aconselhado nos pacientes com EB distrófica. Em 2011, o grupo de ortopedia especializado em mãos do HC‐FMUSP, em conjunto com a equipe de Dermatologia pediátrica, publicou dados de 59 pacientes com EB e deformidades nas mãos, dos quais 25 foram submetidos à cirurgia, com taxa elevada de reoperação.<a class="elsevierStyleCrossRef" href="#bib0330">26</a> Estudo de 2019 do grupo da China<a class="elsevierStyleCrossRef" href="#bib0335">27</a> relatou 11 pacientes EBDR submetidos à cirurgia e com seguimento por dois anos, dos quais nove apresentaram perda da funcionalidade das mãos pelo reestreitamento dos espaços interdigitais, com adesão de dígitos e flexão de articulações metacarpofalangeanas e interfalangeanas. Os outros dois pacientes foram reoperados após um ano em virtude de recidiva.O Registro Nacional de EB (NEBR) dos Estados Unidos com casuística de 3.280 pacientes acompanhados por período de 16 anos (1986‐2002)<a class="elsevierStyleCrossRefs" href="#bib0340">28,29</a> permanece como o maior estudo epidemiológico sobre EB. Demonstrou que a frequência de estenose de esôfago é de 79,1% em pacientes com EBDR grave, 37,2% para EBDR intermediária e 14,3% em EBJ, com frequências menores nos demais subtipos de EB.<a class="elsevierStyleCrossRef" href="#bib0340">28</a> Em nosso estudo, estenose de esôfago foi identificada em 14% do total de indivíduos; 28,4% e 7,7% foram as frequências observadas em pacientes com EBDR e EBJ, respectivamente.Em 2005, foi publicado um trabalho envolvendo a Gastroenterologia e a Dermatologia Pediátrica do HC‐FMUSP,<a class="elsevierStyleCrossRef" href="#bib0350">30</a> que relatou 19 pacientes com formas graves de EB (EBD e EBJ) atendidos entre janeiro de 1999 e abril de 2001. Vômitos e disfagia foram referidos por 16 (84,2%) casos, engasgos por 14 (73,7%) e constipação intestinal por 14 (73,7%) pacientes. Anemia acometeu todos os casos. Em relação aos aspectos nutricionais, 12 (63,1%) apresentavam peso e estatura inferiores ao percentil 2,5.<a class="elsevierStyleCrossRef" href="#bib0350">30</a> No presente estudo, desnutrição acometeu 35 (12%). O menor percentual encontrado está associado à metodologia deste trabalho, que incluiu todas as formas de EB.Nevo EB é descrito como nevo adquirido, eruptivo, assimétrico e acomete cerca de 14% dos portadores de EB, em suas várias formas clínicas.<a class="elsevierStyleCrossRef" href="#bib0355">31</a> Os nevos EB geralmente ocorrem em sítios de bolhas prévias e podem involuir espontaneamente. Entretanto, teoricamente o melanoma poderia surgir a partir do nevo EB ou de lesões pigmentadas que mimetizam clinicamente o nevo EB. Dessa maneira, qualquer mudança morfológica no nevo EB, em especial o surgimento de nodulação ou ulceração, aponta para a realização de estudo histopatológico.<a class="elsevierStyleCrossRef" href="#bib0360">32</a> Neste estudo, nevos EB foram identificados em 17% dos pacientes. Em 2014, a equipe de Dermatologia Pediátrica do HC‐FMUSP descreveu 13 pacientes EBD com nevos EB, cinco dos quais foram biopsiados em virtude das características dermatoscópicas atípicas dos nevos. Dois corresponderam a nevo atípico ou proliferação lentiginosa atípica à avaliação histopatológica.<a class="elsevierStyleCrossRef" href="#bib0235">7</a> Em 2005, um grupo da Áustria<a class="elsevierStyleCrossRef" href="#bib0365">33</a> descreveu características dermatoscópicas de 23 nevos EB de 11 pacientes, com critérios associados a melanoma encontrados, como padrão multicomponentes (20 de 23), rede pigmentada atípica (17 de 23), glóbulos e pontos irregulares (16 de 23), pigmentação irregular (22 de 23) e padrão vascular atípico (7 de 23). O mesmo grupo indicou avaliação histológica de lesões altamente suspeitas.A atresia de piloro associada à EB foi encontrada em uma paciente feminina EBS de 28 anos e com acometimento cutâneo extenso. Trata‐se de um subtipo distinto, que geralmente ocorre em fenótipos graves de EB.<a class="elsevierStyleCrossRef" href="#bib0370">34</a> Quando ocorre concomitantemente à EBS grave, está associada à mutação no gene da plectina (PLEC), proteína formadora do hemidesmossoma.<a class="elsevierStyleCrossRef" href="#bib0210">2</a> O diagnóstico genético da paciente em questão ainda não foi realizado.Um paciente masculino EBS de 22 anos com diagnóstico genético de mutação no gene PLEC apresentou distrofia muscular, como já citado na literatura. Pode estar presente ao nascimento ou nos primeiros dias de vida nas crianças com doença cutânea grave,<a class="elsevierStyleCrossRef" href="#bib0375">35</a> ou pode se estabelecer de forma insidiosa no final da infância ou na vida adulta.<a class="elsevierStyleCrossRef" href="#bib0325">25</a> No estudo holandês de 2021,<a class="elsevierStyleCrossRef" href="#bib0300">20</a> dois pacientes com EBS e distrofia muscular morreram com idades de 43,7 anos e 46 anos por falência cardíaca.O maior risco de cardiomiopatia dilatada é visto entre pacientes EBDR grave, com risco cumulativo de 4,51% aos 20 anos de idade.<a class="elsevierStyleCrossRef" href="#bib0380">36</a> Dentre os pacientes incluídos neste estudo, cardiomiopatia acometeu um paciente EBDR, que foi a óbito aos 20 anos, e um paciente EBK de 30 anos, que perdeu seguimento.Durante o período avaliado, foram realizadas 302 biopsias de pele e 359 imunomapeamentos. Alguns exames foram repetidos em virtude de laudos inconclusivos, pois as bolhas biopsiadas estavam em processo de reepitelização ou a clivagem estava ausente. O exame histológico da biopsia de pele deve ser realizado em uma bolha íntegra (pele acometida) recente. A clivagem é intraepidérmica nos casos de EBS e subepidérmica na EBJ e EBD, não sendo possível diferenciar essas duas formas por meio da histopatologia com coloração de rotina.<a class="elsevierStyleCrossRef" href="#bib0250">10</a> Na EBK, o plano de clivagem é variável. Já o imunomapeamento pode ser realizado em amostra de pele sã com vesícula induzida ou em vesícula recente e idealmente pequena, para que não se rompa no ato da biopsia. Trata‐se de técnica de imunofluorescência e tem a vantagem de possibilitar a visualização do plano de clivagem, permitindo diferenciação entre as formas simples, juncional e distrófica.<a class="elsevierStyleCrossRef" href="#bib0250">10</a> Os marcadores utilizados no Departamento de Dermatologia do HC‐FMUSP são: antígeno do penfigoide bolhoso (marcador de hemidesmossoma), anticorpo antilaminina 5 (lâmina lúcida), anticorpo anticolágeno IV (lâmina densa) e anticorpo anticolágeno VII (sublâmina densa e fibrilas de ancoragem). Na EBS, a clivagem ocorre na camada basal. Na EBJ, o nível de clivagem ocorre na lâmina lúcida, enquanto na EBD ocorre na sublâmina densa (<a class="elsevierStyleCrossRef" href="#fig0035">fig. 7</a>).<a class="elsevierStyleCrossRef" href="#bib0250">10</a> Na EBDR, há ausência ou diminuição acentuada da fluorescência com o colágeno VII. Em 2021, um estudo da Índia<a class="elsevierStyleCrossRef" href="#bib0385">37</a> mostrou a utilidade do imunomapeamento como método diagnóstico, frente à indisponibilidade de microscopia eletrônica e de testes genéticos. Diagnóstico de 104 EBS, 28 EBJ e de 26 EBD foi realizado com taxa de concordância de 41,3%, com maiores taxas nos casos de EBS.<elsevierMultimedia ident="fig0035"></elsevierMultimedia>A pesquisa das mutações nos genes associados à EB é padrão ouro para definição do subtipo de EB e evitaria a realização de biopsia e imunomapeamento. Tem sido realizada de maneira mais rápida e menos custosa, com maiores taxas de detecção mutacional, devido aos avanços na tecnologia de sequenciamento.<a class="elsevierStyleCrossRef" href="#bib0390">38</a> No nosso serviço, teste genético vem sendo realizado no âmbito da pesquisa, porém ainda não está amplamente disponível na prática ambulatorial por não ser exame coberto pelo SUS.Em algumas formas de EB, especialmente na EBDR, há risco aumentado de CEC no final da adolescência e início da vida adulta. Estudo recente do grupo da Austrália e da Nova Zelândia<a class="elsevierStyleCrossRef" href="#bib0395">39</a> mostrou 16 pacientes EBDR com 161 CEC primários, com média de 10 CEC por indivíduo. Desses tumores, 70% surgiram nas mãos e nos pés, principalmente em áreas de úlceras crônicas e de feridas que não cicatrizavam. Metástase foi detectada em 11 (68,7%) desses pacientes. Amputação parcial do membro foi realizado em sete casos.<a class="elsevierStyleCrossRef" href="#bib0395">39</a> Dos nove pacientes diagnosticados com CEC em nosso estudo, sete (77,7%) apresentaram tumor nos membros inferiores e cinco (55,5%) tiveram metástase. Apenas um indivíduo EBJ apresentou mais de um CEC (três tumores), enquanto três pacientes foram submetidos à amputação transtibial. CEC é a principal causa de morte nesse grupo de pacientes, e o risco cumulativo de morte por metástase é de 38,7% aos 35 anos e de 78,8% aos 55 anos de idade. A maioria dos pacientes com EBDR morrem de CEC metastático no período de cinco anos após o diagnóstico.<a class="elsevierStyleCrossRef" href="#bib0345">29</a>O baixo número de óbitos (11) identificado neste estudo pode estar relacionado aos cuidados multidisciplinares dirigidos aos pacientes. Porém, há o viés de informação, pois esse dado somente é registrado no prontuário quando o óbito ocorre em algum hospital do complexo HC‐FMUSP. Informações sobre óbitos que ocorrem em casa ou em outros hospitais não estão disponíveis, pela falta de um banco de dados unificado nacional. Cinco pacientes EBDR foram a óbito com média de idade de 20,4 anos, enquanto a média de idade de óbito de cinco pacientes EBDD foi de 14 anos. A idade média de vida em pacientes com EBD segundo estudo recente na Holanda é de 32,5 anos. Em EBDR, esse valor é de 28,8 anos e em EBDD de 33,3 anos.<a class="elsevierStyleCrossRef" href="#bib0300">20</a>Quanto às principais limitações, por se tratar de um estudo retrospectivo com longo período de avaliação (2000‐2022), houve falta de informações em alguns prontuários médicos e perda de seguimento de pacientes. Outro ponto é a indisponibilidade de testes genéticos de rotina para os pacientes com EB em nosso serviço e no sistema público de saúde, o que pode dificultar a classificação da forma clínica de EB. Apesar desse estudo não ser multicêntrico, representa o primeiro trabalho com dados epidemiológicos de epidermólise bolhosa hereditária na população brasileira.No Brasil, o HC‐FMUSP é um dos poucos centros de referência multidisciplinar especializados em EB. O acesso a esses serviços escassos é difícil, uma vez que depende do encaminhamento das unidades básicas de saúde, que muitas vezes são distantes e localizam‐se até mesmo em outros Estados, de forma que o nosso serviço atende pacientes de todo o país. Outro problema crítico é a falta de suprimento de necessidades básicas dos pacientes, como curativos não‐aderentes e até mesmo curativos simples. Muitas vezes o paciente de EB não é diagnosticado e tratado adequadamente. Há subdiagnóstico e os poucos dados epidemiológicos que são publicados acabam não refletindo a realidade da incidência e prevalência de doenças raras, como a EB. Semelhante ao que ocorre no Canadá, não há centros especializados no cuidado de adultos com EB e esses continuam sendo atendidos em ambulatórios pediátricos. Questões da vida adulta, como sexualidade, emprego, independência e manejo de câncer de pele são tratados com limitações, o que torna necessário o encaminhamento a outras especialidades.<a class="elsevierStyleCrossRef" href="#bib0400">40</a>ConclusãoEm doenças raras como a EB, dados epidemiológicos confiáveis permitem a identificação de tendências epidemiológicas.<a class="elsevierStyleCrossRef" href="#bib0270">14</a> Esse estudo demonstra a predominância de formas mais graves na nossa casuística (EB distrófica), provavelmente por se tratar de um hospital terciário, e ressalta a necessidade de cuidado multidisciplinar, principalmente em relação às comorbidades e às complicações dos pacientes, como anemia, doenças dentárias, ortopédicas e do trato gastrointestinal e carcinoma espinocelular. No Brasil, há a necessidade de criação de banco de dados que unifique informações clínicas de toda a população, a fim de identificar essas tendências e permitir melhor direcionamento das políticas de saúde (verbas e financiamento).Suporte financeiroEstudo patrocinado pela Fundo de Apoio à Dermatologia do Estado de São Paulo (FUNADERSP) [PROJETO 105‐2022] e pelo Departamento de Dermatologia do Hospital das Clínicas da Universidade de São Paulo.Contribuição dos autoresChan I. Thien: concepção e planejamento do estudo; coleta de dados ou análise e interpretação dos dados; análise estatística; elaboração e redação do manuscrito ou revisão crítica de conteúdo intelectual importante; participação efetiva na orientação da pesquisa; participação intelectual em conduta propedêutica e/ou terapêutica de casos estudados; revisão crítica da literatura; aprovação da versão final do manuscrito.Vanessa Rolim Bessa: Coleta de dados, ou análise e interpretação dos dados; análise estatística; participação intelectual em conduta propedêutica e/ou terapêutica de casos estudados; aprovação da versão final do manuscrito.Isadora Zago Miotto: Coleta de dados, ou análise e interpretação dos dados; análise estatística; participação intelectual em conduta propedêutica e/ou terapêutica de casos estudados; aprovação da versão final do manuscrito.Luciana Paula Samorano: Concepção e planejamento do estudo; elaboração e redação do manuscrito ou revisão crítica de conteúdo intelectual importante; participação efetiva na orientação da pesquisa; participação intelectual em conduta propedêutica e/ou terapêutica de casos estudados; aprovação da versão final do manuscrito.Maria Cecília Rivitti Machado: Concepção e planejamento do estudo; elaboração e redação do manuscrito ou revisão crítica de conteúdo intelectual importante; participação efetiva na orientação da pesquisa; participação intelectual em conduta propedêutica e/ou terapêutica de casos estudados; aprovação da versão final do manuscrito.Zilda Najjar Prado de Oliveira: Concepção e planejamento do estudo; elaboração e redação do manuscrito ou revisão crítica de conteúdo intelectual importante; análise estatística; participação efetiva na orientação da pesquisa; participação intelectual em conduta propedêutica e/ou terapêutica de casos estudados; aprovação da versão final do manuscrito.Conflito de interessesNenhum." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres2137114" "titulo" => "Resumo" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Fundamentos" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Limitações do estudo" ] 5 => array:2 [ "identificador" => "abst0030" "titulo" => "Conclusões" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1814634" "titulo" => "Palavras‐chave" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introdução" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Métodos" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Resultados" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussão" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusão" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Suporte financeiro" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Contribuição dos autores" ] 9 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflito de interesses" ] 10 => array:2 [ "identificador" => "xack741578" "titulo" => "Agradecimentos" ] 11 => array:1 [ "titulo" => "Referências" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-03-17" "fechaAceptado" => "2023-06-23" "PalabrasClave" => array:1 [ "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras‐chave" "identificador" => "xpalclavsec1814634" "palabras" => array:7 [ 0 => "Atenção terciária à saúde" 1 => "Brasil" 2 => "Epidemiologia" 3 => "Epidermólise bolhosa" 4 => "Epidermólise bolhosa distrófica" 5 => "Epidermólise bolhosa juncional" 6 => "Epidermólise bolhosa simples" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "FundamentosEpidermólise bolhosa (EB) é um grupo de doenças hereditárias raras, caracterizadas por fragilidade da pele e mucosas. Dados epidemiológicos de EB no Brasil são escassos. ObjetivosDescrever aspectos epidemiológicos de pacientes com EB diagnosticados no Departamento de Dermatologia de um hospital terciário, de 2000 até 2022. MétodosEstudo observacional e retrospectivo foi conduzido por meio da análise de prontuários. Dados avaliados incluíram forma clínica, sexo, história familiar, consanguinidade, idade ao diagnóstico, idade atual, tempo de seguimento, comorbidades, exame histopatológico e imunomapeamento, presença de nevos EB e de carcinomas espinocelulares (CEC), causa e idade da morte. ResultadosDos 309 pacientes com EB hereditária, 278 foram incluídos. O tipo mais comum foi EB distrófica (EBD), com 73% (28,4% EBD dominante, 31,7% EBD recessiva e 12,9% EBD pruriginosa). Outros tipos foram juncional com 9,4%, simples com 16,5% e Kindler com 1,1%. Mulheres corresponderam a 53% e homens a 47%. História familiar foi encontrada em 35% e consanguinidade em 11%. A média de idade ao diagnóstico foi de 10,8 anos, e da idade atual foi de 26 anos. A média do tempo de seguimento foi de nove anos. Estenose de esôfago acometeu 14%, doenças dentárias acometeram 36%, desnutrição 13% e anemia 29% dos indivíduos. Durante a investigação diagnóstica, 72,6% realizaram exame histopatológico e 92% fizeram imunomapeamento. Nevos EB foram identificados em 17%. Nove pacientes tiveram CEC. Onze foram a óbito. Limitações do estudoDados insuficientes nos prontuários, perda de seguimento e indisponibilidade do teste genético. ConclusõesNeste estudo, predominou EB distrófica e ressaltou‐se a necessidade de cuidado multidisciplinar das comorbidades e das complicações." "secciones" => array:6 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Fundamentos" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Limitações do estudo" ] 5 => array:2 [ "identificador" => "abst0030" "titulo" => "Conclusões" ] ] ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Como citar este artigo: Thien CI, Bessa VR, Miotto IZ, Samorano LP, Rivitti‐Machado MC, Oliveira ZN. Hereditary epidermolysis bullosa: clinical‐epidemiological profile of 278 patients at a tertiary hospital in São Paulo, Brazil. An Bras Dermatol. 2024;99:380–90." ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "Trabalho realizado no Departamento de Dermatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil." ] ] "multimedia" => array:11 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1849 "Ancho" => 2508 "Tamanyo" => 544337 ] ] "descripcion" => array:1 [ "pt" => "Epidermólise bolhosa distrófica dominante (EBDD). (A) Forma generalizada acometendo o dorso. A involução das bolhas forma cicatrizes. (B) Pápulas escoriadas nos membros inferiores na EBD pruriginosa." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1126 "Ancho" => 2508 "Tamanyo" => 405128 ] ] "descripcion" => array:1 [ "pt" => "Epidermólise bolhosa distrófica recessiva (EBDR). (A) Bolhas e áreas exulceradas ocasionam cicatrizes e fibrose. (B) Pseudosindactilia das mãos, com a fusão dos dígitos." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 3486 "Ancho" => 1508 "Tamanyo" => 371966 ] ] "descripcion" => array:1 [ "pt" => "Epidermólise bolhosa juncional (EBJ). (A) Defeitos no esmalte dentário na arcada dentária inferior, com depressões puntiformes e coloração amarelada. Na arcada dentária superior é possível observar facetas laminadas (lentes de contato dentárias). (B) Fragilidade cutânea, áreas sem epitelização, outras áreas com tecido de granulação e crostas, no bebê." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figura 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 801 "Ancho" => 2508 "Tamanyo" => 176933 ] ] "descripcion" => array:1 [ "pt" => "Epidermólise bolhosa simples (EBS). (A) Bolhas íntegras, exulcerações e crostas hemáticas na criança. Observar acometimento de áreas de fricção (região periaxilar). (B) Bolhas e erosões cicatrizando nos pés, na forma localizada de EBS." ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figura 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 850 "Ancho" => 2508 "Tamanyo" => 267939 ] ] "descripcion" => array:1 [ "pt" => "Epidermólise bolhosa Kindler (EBK). (A) Lesões cicatriciais de disposição rendilhada, máculas hipo e hipercrômicas na criança com EBK. (B) Poiquilodermia na face. Crostas e exulcerações nos lábios. Dentes em mau estado de conservação." ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figura 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 1892 "Ancho" => 1675 "Tamanyo" => 411663 ] ] "descripcion" => array:1 [ "pt" => "(A) Nevo da epidermólise bolhosa (nevo EB) no cotovelo, em paciente com EBDR. (B) Extensa área com exulceração e lesões de aspecto vegetante, com transformação para carcinoma espinocelular (CEC) no pé." ] ] 6 => array:7 [ "identificador" => "fig0035" "etiqueta" => "Figura 7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr7.jpeg" "Alto" => 2521 "Ancho" => 3341 "Tamanyo" => 691542 ] ] "descripcion" => array:1 [ "pt" => "Imunomapeamento de epidermólise bolhosa distrófica dominante (EBDD). Observar clivagem na sublâmina densa, com depósito dos marcadores e fluorescência no teto da bolha. Os marcadores utilizados são: (A) Antígeno do penfigoide bolhoso, (B) laminina, (C) colágeno IV e (D) colágeno VII." ] ] 7 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Tabela 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Tabela " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="4" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sexo</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="4" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Histórico familiar</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Consanguinidade</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tipo \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">Masc \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">Fem \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sim \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">Não \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">Não informado \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sim \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">Não \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EBS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EBJ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EBDD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EBDR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EBD pruriginosa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 \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 " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EBK</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \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">131 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">147 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">278 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">138 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">278 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">247 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">278 \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">47% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">89% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3522980.png" ] ] ] ] "descripcion" => array:1 [ "pt" => "Distribuição do tipo de epidermólise bolhosa em relação ao sexo, ao histórico familiar e à consanguinidade" ] ] 8 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Tabela 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Tabela " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:2 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="13" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Idade ao diagnóstico</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"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">0 a 1 ano \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">1 a 10 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">11 a 20 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">21 a 30 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">31 a 40 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">41 a 50 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">51 a 60 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">61 a 70 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">71 a 80 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">81 a 90 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EBS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16,5% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EBJ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9,4% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EBDD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28,4% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EBDR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31,7% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EBD pruriginosa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12,9% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EBK \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1,1% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">103 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">278 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3522979.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="13" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Idade atual (ou do óbito)</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"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">0 a 10 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">11 a 20 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">21 a 30 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">31 a 40 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">41 a 50 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">51 a 60 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">61 a 70 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">71 a 80 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">81 a 90 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EBS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16,5% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EBJ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9,4% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EBDD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28,4% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EBDR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31,7% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EBD pruriginosa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12,9% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EBK \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1,1% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">278 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3522982.png" ] ] ] ] "descripcion" => array:1 [ "pt" => "Distribuição do tipo de epidermólise bolhosa quanto à idade ao diagnóstico e quanto à idade atual. No caso de pacientes que foram a óbito, foi considerada a idade da morte" ] ] 9 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Tabela 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Tabela " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="7" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Comorbidades</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"> \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">Estenose de esôfago \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">Alteração dentária \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">Desnutrição \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">Anemia \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">Transfusão sanguínea \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">Alteração ortopédica \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EBS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EBJ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EBDD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EBDR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EBD pruriginosa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EBK \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N° acometidos \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">% (n° acometidos/total pacientes) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3522978.png" ] ] ] ] "descripcion" => array:1 [ "pt" => "Distribuição do tipo de epidermólise bolhosa em relação às principais comorbidades" ] ] 10 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Tabela 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Tabela " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Manifestações extracutâneas</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oftalmológicas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Glaucoma (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Amaurose (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Leucocoria (1) \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">Opacidade da córnea (5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ceratite/ceratopatia (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Estrabismo (1) \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">Úlcera córnea (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Conjuntivite (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Simbléfaro (1) \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">Blefarite (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Descolamento de retina (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Miopia (2) \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">Stafiloma da mácula (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Gastroenterológicas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Estenose de esôfago (40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Megacólon (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Síndrome dispéptica (3) \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">Doença do refluxo gastroesofágico (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Constipação (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Otorrinolaringológicas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Otite (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rouquidão (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Discinesia faríngea (1) \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">Hipoacusia (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Laringomalácia (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tumor do seio maxilar direito (1) \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">Síndrome da apneia e da hipopneia obstrutivas do sono (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Ortopédicas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Pseudosindactilia (56) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Malformação óssea (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Osteomielite (1) \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">Deformidade articular (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Assimetria de membros inferiores (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Endocrinológicas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Hipotireoidismo (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabete mellitus (5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Baixa estatura (2) \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">Osteoporose (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Puberdade tardia (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Puberdade precoce (1) \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">Diabete mellitus insulinodependente (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nódulo tireoideano (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Hematológicas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Anemia (82) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Traço falcêmico (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Deficiência de G‐6‐PD (1) \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">Mieloma múltiplo (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Púrpura trombocitopênica idiopática (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Psiquiátricas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Depressão (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ideação suicida (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Síndrome do pânico (1) \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">Pneumológicas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Asma (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rinite alérgica (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Estenose de traqueia (1) \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">Cardiológicas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Hipertensão arterial (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cardiomiopatia dilatada (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Doença de Chagas (1) \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">Angina (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cardiopatia (CIA, estenose aórtica e pulmonar) (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Urológicas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Infecção urinária (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Criptorquidismo (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Estenose uretral (1) \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">Nefrológicas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Nefropatia (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nefrite por IgA (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3522981.png" ] ] ] ] "descripcion" => array:1 [ "pt" => "Outras manifestações extracutâneas encontradas nos pacientes deste estudo, com o número de indivíduos acometidos entre parênteses" ] ] ] "bibliografia" => array:2 [ "titulo" => "Referências" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:40 [ 0 => array:3 [ "identificador" => "bib0205" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consensus reclassification of inherited epidermolysis bullosa and other disorders with skin fragility" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. 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Marcello Menta Simonsen Nico, professor do Departamento de Dermatologia do HCFMUSP e chefe do ambulatório de Estomatologia do Hospital HC‐FMUSP, que cedeu fotos clínicas para este artigo.Ao dr. Alexandre Marques Périgo, biólogo do Laboratório de Imunopatologia da Pele, do Departamento de Dermatologia do Hospital HC‐FMUSP, que cedeu fotos de imunomapeamento para este artigo." "vista" => "all" ] ] ] "idiomaDefecto" => "pt" "url" => "/26662752/0000009900000003/v1_202404300449/S2666275224000225/v1_202404300449/pt/main.assets" "Apartado" => array:4 [ "identificador" => "89618" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Artigo Original" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/26662752/0000009900000003/v1_202404300449/S2666275224000225/v1_202404300449/pt/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275224000225?idApp=UINPBA00008Z"]

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Epidermólise bolhosa hereditária: perfil clínico‐epidemiológico de 278 pacientes em hospital terciário em São Paulo, Brasil

Chan I. Thien

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ithienchan@gmail.com

Autor para correspondência.

, Vanessa Rolim Bessa, Isadora Zago Miotto, Luciana Paula Samorano, Maria Cecília Rivitti Machado, Zilda Najjar Prado de Oliveira

Departamento de Dermatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil

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em que a clivagem na pele &#233; muito superficial &#40;suprabasal&#41;&#44; como s&#237;ndrome da pele dec&#237;dua&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a> Nas formas cl&#225;ssicas de EB&#44; o quadro cl&#237;nico &#233; heterog&#234;neo&#46; De acordo com o plano de clivagem na pele&#44; as EB s&#227;o divididas em quatro tipos principais&#58; EB simples &#40;EBS&#41;&#44; EB juncional &#40;EBJ&#41;&#44; EB Ddistr&#243;fica &#40;EBD&#41; e EB Kindler &#40;EBK&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a> Mais de 30 subtipos cl&#237;nicos s&#227;o reconhecidos e foram descritas muta&#231;&#245;es patog&#234;nicas em 21 genes distintos&#44; que codificam prote&#237;nas envolvidas na ades&#227;o e integridade celulares&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Dados epidemiol&#243;gicos no Brasil sobre EB s&#227;o escassos&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">3&#44;4</span></a> A associa&#231;&#227;o DEBRA Brasil tem registro de 1&#46;027 pacientes no pa&#237;s&#59; entretanto&#44; esse dado n&#227;o est&#225; publicado&#46; Os estudos brasileiros publicados s&#227;o relatos e s&#233;ries de casos com caracteriza&#231;&#227;o cl&#237;nica e alguns com an&#225;lise gen&#233;tica&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">3&#8211;13</span></a>Em doen&#231;as raras&#44; dados epidemiol&#243;gicos confi&#225;veis&#44; com base em coortes bem caracterizadas&#44; s&#227;o essenciais&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">14</span></a> Ressaltam a necessidade de aten&#231;&#227;o ao cuidado e aos custos para os sistemas de sa&#250;de de um pa&#237;s espec&#237;fico&#46; Tamb&#233;m s&#227;o importantes para o desenvolvimento e execu&#231;&#227;o de estudos cl&#237;nicos e para estimar o n&#250;mero de pacientes que poderiam se beneficiar com determinado tratamento&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a> Estudos cl&#237;nicos de fase 3 com Beremagene Geperpavec &#40;B&#8208;VEC&#41; em pacientes com EBD mostraram resultados promissores quanto &#224; cicatriza&#231;&#227;o de feridas&#46; Trata&#8208;se de terapia t&#243;pica gen&#233;tica associada &#224; edi&#231;&#227;o g&#234;nica&#44; com sequ&#234;ncias de COL7A1 encapsuladas em vetores virais de herpes simples tipo 1&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">O objetivo desse estudo foi descrever os achados cl&#237;nicos e epidemiol&#243;gicos da EB heredit&#225;ria de um hospital terci&#225;rio em S&#227;o Paulo&#44; Brasil&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Estudo observacional&#44; retrospectivo e transversal foi conduzido&#44; ap&#243;s aprova&#231;&#227;o do Comit&#234; de &#201;tica da institui&#231;&#227;o&#44; por meio da an&#225;lise de prontu&#225;rios f&#237;sicos e eletr&#244;nicos de 309 pacientes diagnosticados com EB&#44; na Divis&#227;o de Dermatologia do Hospital das Cl&#237;nicas da Faculdade de Medicina da Universidade de S&#227;o Paulo &#40;HC&#8208;FMUSP&#41;&#44; Brasil&#44; de 1 de janeiro de 2000 a 31 de dezembro de 2022&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">O diagn&#243;stico foi baseado na apresenta&#231;&#227;o cl&#237;nica&#44; hist&#243;ria familiar&#44; comorbidades e nos exames histol&#243;gico e de imunomapeamento obtidos por meio de material de biopsia de pele&#46; Os diagn&#243;sticos foram agrupados nas seguintes categorias&#58; EBS&#44; EBJ&#44; EBD dominante &#40;EBDD&#41;&#44; EBD recessiva &#40;EBDR&#41;&#44; EBD pruriginosa e EBK&#46; Pacientes com dados incompletos ou prontu&#225;rios m&#233;dicos indispon&#237;veis foram exclu&#237;dos&#44; assim como as doen&#231;as com clivagem suprabasal &#40;consenso de 2020&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a> Indiv&#237;duos com a doen&#231;a e familiares tamb&#233;m acometidos que n&#227;o estavam registrados no nosso servi&#231;o n&#227;o foram ativamente recrutados&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">O banco de dados utilizado nesse estudo incluiu forma cl&#237;nica de EB&#44; sexo&#44; hist&#243;ria familiar de EB&#44; presen&#231;a de consanguinidade&#44; idade de diagn&#243;stico&#44; idade atual&#44; tempo de seguimento&#44; comorbidades&#44; realiza&#231;&#227;o de exame histol&#243;gico e de imunomapeamento&#44; presen&#231;a de nevos EB e de tumores cut&#226;neos&#44; causa e idade de morte &#40;se aplic&#225;vel&#41;&#46; Teste gen&#233;tico n&#227;o foi inclu&#237;do&#44; pois n&#227;o &#233; ainda rotineiramente dispon&#237;vel no servi&#231;o&#46; Dados estat&#237;sticos foram apresentados como porcentagens e m&#233;dias&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0040" class="elsevierStylePara elsevierViewall">No total&#44; dos 309 pacientes com EB&#44; 31 foram exclu&#237;dos&#44; devido a dados incompletos&#46; No total de&#160;278&#160;pacientes inclu&#237;dos&#44; 147 &#40;53&#37;&#41; eram mulheres e 131 &#40;47&#37;&#41;&#44; homens&#46; O tipo mais comum foi a forma distr&#243;fica&#44; com 203 pacientes &#40;73&#37;&#41;&#44; dentre os quais 79 &#40;28&#44;4&#37;&#41; s&#227;o EBDD &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1A</a>&#41;&#44; 36 &#40;12&#44;9&#37;&#41; s&#227;o EBD pruriginosa &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1B</a>&#41; e 88 &#40;31&#44;7&#37;&#41; s&#227;o EBDR &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; Outros tipos foram EBJ &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41; com 26 &#40;9&#44;4&#37;&#41; pacientes&#44; EBS &#40;<a class="elsevierStyleCrossRef" href="#fig0020">fig&#46; 4</a>&#41; com 46 &#40;16&#44;5&#37;&#41; e tipo Kindler &#40;<a class="elsevierStyleCrossRef" href="#fig0025">fig&#46; 5</a>&#41; em 3 &#40;1&#44;1&#37;&#41;&#46; Hist&#243;ria familiar positiva foi encontrada em 96 &#40;35&#37;&#41; pacientes&#46; Relato de consanguinidade esteve presente em 31 &#40;11&#37;&#41; pacientes&#46; A distribui&#231;&#227;o dos pacientes pelo tipo de EB em rela&#231;&#227;o ao sexo&#44; ao hist&#243;rico familiar e &#224; consanguinidade pode ser observada na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">A m&#233;dia de idade ao diagn&#243;stico foi de 10&#44;8 anos &#40;variou de 1 dia de vida at&#233; 82 anos&#44; conforme detalhado na <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46; Noventa e tr&#234;s &#40;33&#44;5&#37;&#41; pacientes foram diagnosticados com menos de 1 ano de vida&#44; enquanto 103 &#40;37&#37;&#41; tinham entre 1 e 10 anos&#46; Entre 11 e 20 anos de idade&#44; 29 &#40;10&#37;&#41; pacientes foram diagnosticados&#46; Entre 21 e 80 anos&#44; 52 &#40;19&#37;&#41; pacientes obtiveram diagn&#243;stico de EB&#44; enquanto somente um paciente masculino tinha 82 anos&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Em rela&#231;&#227;o &#224; idade atual &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#44; a m&#233;dia foi de 26 anos&#46; Para o c&#225;lculo&#44; a idade considerada no caso dos pacientes que foram &#224; &#243;bito foi a idade da morte&#46; Somente 40 &#40;14&#37;&#41; indiv&#237;duos tinham menos de 10 anos&#44; enquanto 92 &#40;33&#37;&#41; pacientes tinham entre 11 e 20 anos&#46; Na faixa et&#225;ria entre 21 e 80 anos&#44; havia 143 &#40;51&#37;&#41; pacientes&#44; enquanto tr&#234;s tinham mais de 81 anos&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">A m&#233;dia do tempo de seguimento foi de 9 anos&#44; exclu&#237;dos seis pacientes que compareceram somente para exame diagn&#243;stico e n&#227;o compareceram para seguimento no ambulat&#243;rio&#46; Para os pacientes falecidos&#44; foi considerada a data da &#250;ltima consulta antes de o &#243;bito acontecer&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Em rela&#231;&#227;o ao comprometimento extracut&#226;neo &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#44; 40 &#40;14&#37;&#41; pacientes tiveram diferentes graus de disfagia &#40;estenose de es&#244;fago&#41;&#46; Desses&#44; 25 &#40;62&#44;5&#37;&#41; s&#227;o EBDR&#44; 10 &#40;25&#37;&#41; s&#227;o EBDD&#44; dois &#40;5&#37;&#41; s&#227;o EBD pruriginosa&#44; dois &#40;5&#37;&#41; s&#227;o EBJ&#44; um &#40;2&#44;5&#37;&#41; &#233; EBS e nenhum &#233; EBK&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Doen&#231;as dent&#225;rias foram identificadas em 100 &#40;36&#37;&#41; pacientes&#44; dentre os quais 54 &#40;54&#37;&#41; s&#227;o EBDR&#44; 28 &#40;28&#37;&#41; s&#227;o EBDD&#44; 13 &#40;13&#37;&#41; s&#227;o EBS&#44; tr&#234;s &#40;3&#37;&#41; s&#227;o EBJ&#44; dois &#40;2&#37;&#41; s&#227;o EBK e nenhum &#233; EBD pruriginosa&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Desnutri&#231;&#227;o foi avaliada por meio do &#237;ndice de massa corporal &#40;IMC &#8804; 18&#41; e acometeu 35 &#40;13&#37;&#41; indiv&#237;duos&#46; Desses&#44; 24 &#40;68&#44;6&#37;&#41; s&#227;o EBDR&#44; seis &#40;17&#44;1&#37;&#41; s&#227;o EBDD&#44; tr&#234;s &#40;8&#44;5&#37;&#41; s&#227;o EBS&#44; um &#40;2&#44;9&#37;&#41; &#233; EBJ e um &#40;2&#44;9&#37;&#41; &#233; EBK&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Anemia foi achado frequente&#44; com 81 &#40;29&#37;&#41; pacientes acometidos&#59; seis &#40;2&#37;&#41; deles foram submetidos a transfus&#245;es sangu&#237;neas&#44; todos EBDR&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Acometimento ortop&#233;dico foi observado em 67&#160;&#40;24&#37;&#41; pacientes e aqueles com pseudosindactilia nas m&#227;os &#40;59 pacientes&#41; foram encaminhados ao ambulat&#243;rio de ortopedia&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Nevos da epiderm&#243;lise bolhosa &#40;nevos EB&#41; foram identificados em 47 &#40;17&#37;&#41; indiv&#237;duos&#44; no total de 90 nevos&#44; uma vez que um mesmo paciente apresentou de uma a cinco les&#245;es &#40;<a class="elsevierStyleCrossRef" href="#fig0030">fig&#46; 6A</a>&#41;&#46; Dez pacientes eram EBDD&#44; 29 eram EBDR&#44; dois eram EBJ&#44; cinco eram EBS e um era EBD pruriginosa&#46;</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Atresia de piloro foi identificada em uma paciente EBS com acometimento cut&#226;neo grave&#46; Distrofia muscular foi observada em um paciente EBS&#46; Cardiomiopatia dilatada foi identificada em um paciente EBK de 30 anos que perdeu seguimento e em um paciente EBDR&#44; que foi a &#243;bito aos 20 anos&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Altera&#231;&#245;es dermatol&#243;gicas n&#227;o relacionadas &#224; EB incluem dermatite seborreica &#40;1&#41;&#44; dermatite at&#243;pica &#40;1&#41;&#44; pseudot&#237;nea amiant&#225;cea &#40;1&#41;&#46; Foliculite decalvante foi identificada em dois indiv&#237;duos&#44; ambos com a forma distr&#243;fica de EB&#46; Alopecia cicatricial acometeu duas pacientes EBJ&#46; A <a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a> mostra outras doen&#231;as extracut&#226;neas encontradas nos pacientes dessa coorte&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">No processo de investiga&#231;&#227;o diagn&#243;stica&#44; 202 &#40;72&#44;6&#37;&#41; indiv&#237;duos foram submetidos ao total de 302 biopsias para exame histol&#243;gico&#46; Imunomapeamento foi realizado em 256 &#40;92&#37;&#41; pacientes&#44; com total de 359 exames realizados nesse per&#237;odo&#46; Nove realizaram somente biopsia&#44; 63 realizaram somente imunomapeamento&#44; 193 pacientes foram submetidos a ambos os exames e 13 n&#227;o fizeram nenhum&#46; A classifica&#231;&#227;o do tipo de EB dos 13 pacientes que n&#227;o realizaram nenhum exame levou em considera&#231;&#227;o hist&#243;ria familiar e quadro cl&#237;nico compat&#237;vel&#44; apesar de o diagn&#243;stico n&#227;o ter sido confirmado laboratorialmente&#46; Esses pacientes n&#227;o foram submetidos &#224; biopsia de pele ou imunomapeamento por quest&#245;es sociais &#40;indisponibilidade de retornar ao hospital&#41; ou por falta de consentimento dos respons&#225;veis ou dos pr&#243;prios pacientes &#40;cinco rec&#233;m&#8208;natos&#44; cinco crian&#231;as menores de 12 anos e tr&#234;s adultos&#44; idades 17&#44; 27 e 49 anos&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Durante o per&#237;odo de seguimento&#44; nove &#40;3&#44;2&#37;&#41; pacientes foram diagnosticados com 11 carcinomas espinocelulares &#40;CEC&#41;&#46; Um paciente EBJ apresentou tr&#234;s CEC &#40;um em cada membro inferior e um no dorso&#41;&#46; A localiza&#231;&#227;o do CEC &#40;<a class="elsevierStyleCrossRef" href="#fig0030">fig&#46; 6B</a>&#41; nos demais pacientes foi nos membros inferiores em seis &#40;um EBJ&#44; quatro EBDR e um EBDD&#41; e dorso em um paciente &#40;EBDR&#41;&#46; Em uma das pacientes EBDR&#44; o local do CEC &#233; desconhecido&#44; por falta de informa&#231;&#227;o nos registros m&#233;dicos&#46; Amputa&#231;&#227;o transtibial foi realizada em tr&#234;s pacientes &#40;dois homens EBDR aos 18 e aos 19 anos e uma mulher EBDD aos 27 anos&#41;&#46; Cinco &#40;55&#44;5&#37;&#41; apresentaram met&#225;stase e foram a &#243;bito&#44; dentre os quais tr&#234;s EBDR &#40;a idade do &#243;bito de dois foi aos 18 anos e de um foi aos 20 anos&#41;&#44; um EBDD &#40;28 anos&#41; e um EBJ &#40;57 anos&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">No total&#44; 11 pacientes foram a &#243;bito&#44; cinco EBDR &#40;18&#44; 18&#44; 20&#44; 22 e 24 anos&#41;&#44; cinco EBDD &#40;1&#44; 11&#44; 15&#44; 15&#44; 28 anos&#41; e um EBJ &#40;57 anos&#41;&#46; Causa de morte de cinco destes foi por complica&#231;&#245;es de CEC metast&#225;tico&#46; Tr&#234;s foram a &#243;bito em virtude de sepse por broncopneumonia &#40;dois EBDD&#44; ambos com 15 anos&#44; e um EBDR de 22 anos&#41;&#46; Um paciente EBDR de 24 anos teve broncoaspira&#231;&#227;o como causa de morte&#46; Duas crian&#231;as EBDD&#44; de 1 ano e de 11 anos&#44; foram a &#243;bito sem causa conhecida&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Pacientes que n&#227;o compareceram a consultas na dermatologia e em outras especialidades no HC&#8208;FMUSP h&#225; mais de dois anos foram considerados perda de seguimento&#46; No total&#44; 158 &#40;57&#37;&#41; pacientes tiveram data da &#250;ltima consulta antes de 31&#47;12&#47;2020&#46; Entre 2021 e 2022&#44; tr&#234;s pacientes foram a &#243;bito&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0120" class="elsevierStylePara elsevierViewall">Em nosso estudo de EB heredit&#225;ria&#44; n&#227;o observamos predile&#231;&#227;o por sexo&#59; o n&#250;mero de mulheres e homens acometidos foi semelhante&#44; conforme previamente descrito na literatura&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2&#44;17</span></a> A forma distr&#243;fica de EB foi a mais frequente &#40;73&#44;4&#37;&#41;&#44; propor&#231;&#227;o semelhante &#224; encontrada em estudo realizado no Ir&#227; &#40;75&#44;7&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> Estudos de outros pa&#237;ses descreveram frequ&#234;ncia menor de EBD&#44; como Canad&#225; &#40;35&#37;&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">18</span></a> Austr&#225;lia &#40;35&#37;&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a> Holanda<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a> com 34&#44;7&#37; &#40;EBDD 23&#44;1&#37; e EBDR 11&#44;4&#37;&#41;&#44; Alemanha &#40;32&#44;5&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a> e &#205;ndia &#40;17&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">22</span></a> A predomin&#226;ncia de formas mais graves de EB em nosso estudo se deve&#44; em parte&#44; a dificuldades de acesso a atendimento m&#233;dico especializado<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">23</span></a> em nosso pa&#237;s e subdiagn&#243;stico das formas mais localizadas de EBS e ao fato de o HC&#8208;FMUSP ser hospital terci&#225;rio&#44; refer&#234;ncia nacional no atendimento de paciente com EB&#44; e atender casos de mais alta complexidade&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">No presente estudo&#44; EBS acometeu 16&#44;5&#37; dos pacientes&#44; enquanto EBJ 9&#44;4&#37; dos pacientes e EBK 1&#44;1&#37;&#46; A frequ&#234;ncia de EBJ no estudo do Ir&#227;&#44;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> Canad&#225;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">18</span></a> e Austr&#225;lia<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a> foi de 11&#37;&#59; na Holanda<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a> de 18&#44;8&#37; e na Alemanha&#44;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a> 17&#44;1&#37;&#46; J&#225; EBK&#44; 3&#37; no Ir&#227;&#44;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> 0&#44;3&#37; na Austr&#225;lia&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a> 0&#44;9&#37; na Holanda<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a> e 0&#44;5&#37; na Alemanha&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a> Em ambos os tipos de EB&#44; as porcentagens encontradas em nosso estudo foram semelhantes&#46; Em rela&#231;&#227;o &#224; EBS&#44; a frequ&#234;ncia encontrada &#233; menor do que a descrita na literatura&#44; uma vez que a popula&#231;&#227;o estudada adv&#233;m de hospital terci&#225;rio&#46; Segundo estudo epidemiol&#243;gico de 2021<span class="elsevierStyleHsp" style=""></span>da Holanda&#44;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a> EBS foi diagnosticada em 45&#44;7&#37;&#46; Nessa coorte holandesa&#44; 90&#44;5&#37; dos pacientes tiveram diagn&#243;stico geneticamente confirmado&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a> Dados epidemiol&#243;gicos de 1&#46;779 pacientes da Alemanha&#44; publicados em 2022&#44;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a> mostraram 39&#44;3&#37; &#40;700&#41; de pacientes EBS&#46; Este estudo incluiu pacientes de hospitais terci&#225;rios&#44; ambulat&#243;rios de Dermatologia&#44; laborat&#243;rios que realizaram o diagn&#243;stico e de organiza&#231;&#245;es de pacientes&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">A m&#233;dia da idade atual encontrada em nosso estudo foi de 26 anos&#44; e somente 40 &#40;14&#37;&#41; indiv&#237;duos tinham menos de 10 anos&#46; O elevado n&#250;mero de pacientes na idade puberal&#44; ou seja&#44; acima de 11 anos&#44; permite inferir aumento na expectativa de vida e reflete a melhora nos cuidados multidisciplinares&#44; principalmente em rela&#231;&#227;o &#224; nutri&#231;&#227;o&#44; infec&#231;&#227;o e manejo da dor&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Quanto &#224; consanguinidade&#44; apenas 31 pacientes &#40;11&#37;&#41; declararam sua ocorr&#234;nci&#44; e a EBDR foi o tipo que mais acometeu a popula&#231;&#227;o em estudo &#40;25&#44;8&#37;&#41;&#46; Como a maioria dos pacientes n&#227;o realizou teste gen&#233;tico&#44; o diagn&#243;stico n&#227;o foi confirmado por esse m&#233;todo&#46; Na literatura&#44; &#233; relatado que o n&#250;mero de pacientes com forma autoss&#244;mica recessiva de EB pode estar associado &#224;s comunidades com altas taxas de consanguinidade parental&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">24</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">As queixas mais comuns dos pacientes foram altera&#231;&#245;es dent&#225;rias &#40;36&#37;&#41;&#44; seguido por anemia &#40;29&#37;&#41; e doen&#231;as ortop&#233;dicas &#40;24&#37;&#41;&#46; No estudo do Ir&#227;&#44; foi disfagia seguido de altera&#231;&#245;es dent&#225;rias&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> Esses achados dent&#225;rios se devem na EBJ &#224; hipoplasia do esmalte dent&#225;rio e presen&#231;a de depress&#245;es puntiformes &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3A</a>&#41;&#44; que s&#227;o achados cl&#237;nicos patognom&#244;nicos nessa forma de EB&#46; Essas altera&#231;&#245;es acarretam perda precoce de dentes e c&#225;ries&#46; Na EBDR&#44; microstomia e anquiloglossia s&#227;o observadas e dificultam a higiene dental di&#225;ria&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">25</span></a> Deve&#8208;se sempre levar em considera&#231;&#227;o os cuidados prec&#225;rios de higiene bucal na maioria dos doentes com EB &#40;<a class="elsevierStyleCrossRef" href="#fig0025">fig&#46; 5B</a>&#41;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Pseudosindactilia das m&#227;os &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2B</a>&#41; e dos p&#233;s &#233; complica&#231;&#227;o m&#250;sculo&#8208;esquel&#233;tica que ocorre principalmente na EBDR&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">25</span></a> O uso de luvas ou curativos para manter os quirod&#225;ctilos separados &#233; aconselhado nos pacientes com EB distr&#243;fica&#46; Em 2011&#44; o grupo de ortopedia especializado em m&#227;os do HC&#8208;FMUSP&#44; em conjunto com a equipe de Dermatologia pedi&#225;trica&#44; publicou dados de 59 pacientes com EB e deformidades nas m&#227;os&#44; dos quais 25 foram submetidos &#224; cirurgia&#44; com taxa elevada de reopera&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a> Estudo de 2019 do grupo da China<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">27</span></a> relatou 11 pacientes EBDR submetidos &#224; cirurgia e com seguimento por dois anos&#44; dos quais nove apresentaram perda da funcionalidade das m&#227;os pelo reestreitamento dos espa&#231;os interdigitais&#44; com ades&#227;o de d&#237;gitos e flex&#227;o de articula&#231;&#245;es metacarpofalangeanas e interfalangeanas&#46; Os outros dois pacientes foram reoperados ap&#243;s um ano em virtude de recidiva&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">O Registro Nacional de EB &#40;NEBR&#41; dos Estados Unidos com casu&#237;stica de 3&#46;280 pacientes acompanhados por per&#237;odo de 16 anos &#40;1986&#8208;2002&#41;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">28&#44;29</span></a> permanece como o maior estudo epidemiol&#243;gico sobre EB&#46; Demonstrou que a frequ&#234;ncia de estenose de es&#244;fago &#233; de 79&#44;1&#37; em pacientes com EBDR grave&#44; 37&#44;2&#37; para EBDR intermedi&#225;ria e 14&#44;3&#37; em EBJ&#44; com frequ&#234;ncias menores nos demais subtipos de EB&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">28</span></a> Em nosso estudo&#44; estenose de es&#244;fago foi identificada em 14&#37; do total de indiv&#237;duos&#59; 28&#44;4&#37; e 7&#44;7&#37; foram as frequ&#234;ncias observadas em pacientes com EBDR e EBJ&#44; respectivamente&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Em 2005&#44; foi publicado um trabalho envolvendo a Gastroenterologia e a Dermatologia Pedi&#225;trica do HC&#8208;FMUSP&#44;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a> que relatou 19 pacientes com formas graves de EB &#40;EBD e EBJ&#41; atendidos entre janeiro de 1999 e abril de 2001&#46; V&#244;mitos e disfagia foram referidos por 16 &#40;84&#44;2&#37;&#41; casos&#44; engasgos por 14 &#40;73&#44;7&#37;&#41; e constipa&#231;&#227;o intestinal por 14 &#40;73&#44;7&#37;&#41; pacientes&#46; Anemia acometeu todos os casos&#46; Em rela&#231;&#227;o aos aspectos nutricionais&#44; 12 &#40;63&#44;1&#37;&#41; apresentavam peso e estatura inferiores ao percentil 2&#44;5&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a> No presente estudo&#44; desnutri&#231;&#227;o acometeu 35 &#40;12&#37;&#41;&#46; O menor percentual encontrado est&#225; associado &#224; metodologia deste trabalho&#44; que incluiu todas as formas de EB&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Nevo EB &#233; descrito como nevo adquirido&#44; eruptivo&#44; assim&#233;trico e acomete cerca de 14&#37; dos portadores de EB&#44; em suas v&#225;rias formas cl&#237;nicas&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">31</span></a> Os nevos EB geralmente ocorrem em s&#237;tios de bolhas pr&#233;vias e podem involuir espontaneamente&#46; Entretanto&#44; teoricamente o melanoma poderia surgir a partir do nevo EB ou de les&#245;es pigmentadas que mimetizam clinicamente o nevo EB&#46; Dessa maneira&#44; qualquer mudan&#231;a morfol&#243;gica no nevo EB&#44; em especial o surgimento de nodula&#231;&#227;o ou ulcera&#231;&#227;o&#44; aponta para a realiza&#231;&#227;o de estudo histopatol&#243;gico&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">32</span></a> Neste estudo&#44; nevos EB foram identificados em 17&#37; dos pacientes&#46; Em 2014&#44; a equipe de Dermatologia Pedi&#225;trica do HC&#8208;FMUSP descreveu 13 pacientes EBD com nevos EB&#44; cinco dos quais foram biopsiados em virtude das caracter&#237;sticas dermatosc&#243;picas at&#237;picas dos nevos&#46; Dois corresponderam a nevo at&#237;pico ou prolifera&#231;&#227;o lentiginosa at&#237;pica &#224; avalia&#231;&#227;o histopatol&#243;gica&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a> Em 2005&#44; um grupo da &#193;ustria<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">33</span></a> descreveu caracter&#237;sticas dermatosc&#243;picas de 23 nevos EB de 11 pacientes&#44; com crit&#233;rios associados a melanoma encontrados&#44; como padr&#227;o multicomponentes &#40;20 de 23&#41;&#44; rede pigmentada at&#237;pica &#40;17 de 23&#41;&#44; gl&#243;bulos e pontos irregulares &#40;16 de 23&#41;&#44; pigmenta&#231;&#227;o irregular &#40;22 de 23&#41; e padr&#227;o vascular at&#237;pico &#40;7 de 23&#41;&#46; O mesmo grupo indicou avalia&#231;&#227;o histol&#243;gica de les&#245;es altamente suspeitas&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">A atresia de piloro associada &#224; EB foi encontrada em uma paciente feminina EBS de 28 anos e com acometimento cut&#226;neo extenso&#46; Trata&#8208;se de um subtipo distinto&#44; que geralmente ocorre em fen&#243;tipos graves de EB&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">34</span></a> Quando ocorre concomitantemente &#224; EBS grave&#44; est&#225; associada &#224; muta&#231;&#227;o no gene da plectina &#40;PLEC&#41;&#44; prote&#237;na formadora do hemidesmossoma&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a> O diagn&#243;stico gen&#233;tico da paciente em quest&#227;o ainda n&#227;o foi realizado&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Um paciente masculino EBS de 22 anos com diagn&#243;stico gen&#233;tico de muta&#231;&#227;o no gene PLEC apresentou distrofia muscular&#44; como j&#225; citado na literatura&#46; Pode estar presente ao nascimento ou nos primeiros dias de vida nas crian&#231;as com doen&#231;a cut&#226;nea grave&#44;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">35</span></a> ou pode se estabelecer de forma insidiosa no final da inf&#226;ncia ou na vida adulta&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">25</span></a> No estudo holand&#234;s de 2021&#44;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a> dois pacientes com EBS e distrofia muscular morreram com idades de 43&#44;7 anos e 46 anos por fal&#234;ncia card&#237;aca&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">O maior risco de cardiomiopatia dilatada &#233; visto entre pacientes EBDR grave&#44; com risco cumulativo de 4&#44;51&#37; aos 20 anos de idade&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">36</span></a> Dentre os pacientes inclu&#237;dos neste estudo&#44; cardiomiopatia acometeu um paciente EBDR&#44; que foi a &#243;bito aos 20 anos&#44; e um paciente EBK de 30 anos&#44; que perdeu seguimento&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Durante o per&#237;odo avaliado&#44; foram realizadas 302 biopsias de pele e 359 imunomapeamentos&#46; Alguns exames foram repetidos em virtude de laudos inconclusivos&#44; pois as bolhas biopsiadas estavam em processo de reepiteliza&#231;&#227;o ou a clivagem estava ausente&#46; O exame histol&#243;gico da biopsia de pele deve ser realizado em uma bolha &#237;ntegra &#40;pele acometida&#41; recente&#46; A clivagem &#233; intraepid&#233;rmica nos casos de EBS e subepid&#233;rmica na EBJ e EBD&#44; n&#227;o sendo poss&#237;vel diferenciar essas duas formas por meio da histopatologia com colora&#231;&#227;o de rotina&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">10</span></a> Na EBK&#44; o plano de clivagem &#233; vari&#225;vel&#46; J&#225; o imunomapeamento pode ser realizado em amostra de pele s&#227; com ves&#237;cula induzida ou em ves&#237;cula recente e idealmente pequena&#44; para que n&#227;o se rompa no ato da biopsia&#46; Trata&#8208;se de t&#233;cnica de imunofluoresc&#234;ncia e tem a vantagem de possibilitar a visualiza&#231;&#227;o do plano de clivagem&#44; permitindo diferencia&#231;&#227;o entre as formas simples&#44; juncional e distr&#243;fica&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">10</span></a> Os marcadores utilizados no Departamento de Dermatologia do HC&#8208;FMUSP s&#227;o&#58; ant&#237;geno do penfigoide bolhoso &#40;marcador de hemidesmossoma&#41;&#44; anticorpo antilaminina 5 &#40;l&#226;mina l&#250;cida&#41;&#44; anticorpo anticol&#225;geno IV &#40;l&#226;mina densa&#41; e anticorpo anticol&#225;geno VII &#40;subl&#226;mina densa e fibrilas de ancoragem&#41;&#46; Na EBS&#44; a clivagem ocorre na camada basal&#46; Na EBJ&#44; o n&#237;vel de clivagem ocorre na l&#226;mina l&#250;cida&#44; enquanto na EBD ocorre na subl&#226;mina densa &#40;<a class="elsevierStyleCrossRef" href="#fig0035">fig&#46; 7</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">10</span></a> Na EBDR&#44; h&#225; aus&#234;ncia ou diminui&#231;&#227;o acentuada da fluoresc&#234;ncia com o col&#225;geno VII&#46; Em 2021&#44; um estudo da &#205;ndia<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">37</span></a> mostrou a utilidade do imunomapeamento como m&#233;todo diagn&#243;stico&#44; frente &#224; indisponibilidade de microscopia eletr&#244;nica e de testes gen&#233;ticos&#46; Diagn&#243;stico de 104 EBS&#44; 28 EBJ e de 26 EBD foi realizado com taxa de concord&#226;ncia de 41&#44;3&#37;&#44; com maiores taxas nos casos de EBS&#46;</p><elsevierMultimedia ident="fig0035"></elsevierMultimedia><p id="par0185" class="elsevierStylePara elsevierViewall">A pesquisa das muta&#231;&#245;es nos genes associados &#224; EB &#233; padr&#227;o ouro para defini&#231;&#227;o do subtipo de EB e evitaria a realiza&#231;&#227;o de biopsia e imunomapeamento&#46; Tem sido realizada de maneira mais r&#225;pida e menos custosa&#44; com maiores taxas de detec&#231;&#227;o mutacional&#44; devido aos avan&#231;os na tecnologia de sequenciamento&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">38</span></a> No nosso servi&#231;o&#44; teste gen&#233;tico vem sendo realizado no &#226;mbito da pesquisa&#44; por&#233;m ainda n&#227;o est&#225; amplamente dispon&#237;vel na pr&#225;tica ambulatorial por n&#227;o ser exame coberto pelo SUS&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Em algumas formas de EB&#44; especialmente na EBDR&#44; h&#225; risco aumentado de CEC no final da adolesc&#234;ncia e in&#237;cio da vida adulta&#46; Estudo recente do grupo da Austr&#225;lia e da Nova Zel&#226;ndia<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">39</span></a> mostrou 16 pacientes EBDR com 161 CEC prim&#225;rios&#44; com m&#233;dia de 10 CEC por indiv&#237;duo&#46; Desses tumores&#44; 70&#37; surgiram nas m&#227;os e nos p&#233;s&#44; principalmente em &#225;reas de &#250;lceras cr&#244;nicas e de feridas que n&#227;o cicatrizavam&#46; Met&#225;stase foi detectada em 11 &#40;68&#44;7&#37;&#41; desses pacientes&#46; Amputa&#231;&#227;o parcial do membro foi realizado em sete casos&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">39</span></a> Dos nove pacientes diagnosticados com CEC em nosso estudo&#44; sete &#40;77&#44;7&#37;&#41; apresentaram tumor nos membros inferiores e cinco &#40;55&#44;5&#37;&#41; tiveram met&#225;stase&#46; Apenas um indiv&#237;duo EBJ apresentou mais de um CEC &#40;tr&#234;s tumores&#41;&#44; enquanto tr&#234;s pacientes foram submetidos &#224; amputa&#231;&#227;o transtibial&#46; CEC &#233; a principal causa de morte nesse grupo de pacientes&#44; e o risco cumulativo de morte por met&#225;stase &#233; de 38&#44;7&#37; aos 35 anos e de 78&#44;8&#37; aos 55 anos de idade&#46; A maioria dos pacientes com EBDR morrem de CEC metast&#225;tico no per&#237;odo de cinco anos ap&#243;s o diagn&#243;stico&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">29</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">O baixo n&#250;mero de &#243;bitos &#40;11&#41; identificado neste estudo pode estar relacionado aos cuidados multidisciplinares dirigidos aos pacientes&#46; Por&#233;m&#44; h&#225; o vi&#233;s de informa&#231;&#227;o&#44; pois esse dado somente &#233; registrado no prontu&#225;rio quando o &#243;bito ocorre em algum hospital do complexo HC&#8208;FMUSP&#46; Informa&#231;&#245;es sobre &#243;bitos que ocorrem em casa ou em outros hospitais n&#227;o est&#227;o dispon&#237;veis&#44; pela falta de um banco de dados unificado nacional&#46; Cinco pacientes EBDR foram a &#243;bito com m&#233;dia de idade de 20&#44;4 anos&#44; enquanto a m&#233;dia de idade de &#243;bito de cinco pacientes EBDD foi de 14 anos&#46; A idade m&#233;dia de vida em pacientes com EBD segundo estudo recente na Holanda &#233; de 32&#44;5 anos&#46; Em EBDR&#44; esse valor &#233; de 28&#44;8 anos e em EBDD de 33&#44;3 anos&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">Quanto &#224;s principais limita&#231;&#245;es&#44; por se tratar de um estudo retrospectivo com longo per&#237;odo de avalia&#231;&#227;o &#40;2000&#8208;2022&#41;&#44; houve falta de informa&#231;&#245;es em alguns prontu&#225;rios m&#233;dicos e perda de seguimento de pacientes&#46; Outro ponto &#233; a indisponibilidade de testes gen&#233;ticos de rotina para os pacientes com EB em nosso servi&#231;o e no sistema p&#250;blico de sa&#250;de&#44; o que pode dificultar a classifica&#231;&#227;o da forma cl&#237;nica de EB&#46; Apesar desse estudo n&#227;o ser multic&#234;ntrico&#44; representa o primeiro trabalho com dados epidemiol&#243;gicos de epiderm&#243;lise bolhosa heredit&#225;ria na popula&#231;&#227;o brasileira&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">No Brasil&#44; o HC&#8208;FMUSP &#233; um dos poucos centros de refer&#234;ncia multidisciplinar especializados em EB&#46; O acesso a esses servi&#231;os escassos &#233; dif&#237;cil&#44; uma vez que depende do encaminhamento das unidades b&#225;sicas de sa&#250;de&#44; que muitas vezes s&#227;o distantes e localizam&#8208;se at&#233; mesmo em outros Estados&#44; de forma que o nosso servi&#231;o atende pacientes de todo o pa&#237;s&#46; Outro problema cr&#237;tico &#233; a falta de suprimento de necessidades b&#225;sicas dos pacientes&#44; como curativos n&#227;o&#8208;aderentes e at&#233; mesmo curativos simples&#46; Muitas vezes o paciente de EB n&#227;o &#233; diagnosticado e tratado adequadamente&#46; H&#225; subdiagn&#243;stico e os poucos dados epidemiol&#243;gicos que s&#227;o publicados acabam n&#227;o refletindo a realidade da incid&#234;ncia e preval&#234;ncia de doen&#231;as raras&#44; como a EB&#46; Semelhante ao que ocorre no Canad&#225;&#44; n&#227;o h&#225; centros especializados no cuidado de adultos com EB e esses continuam sendo atendidos em ambulat&#243;rios pedi&#225;tricos&#46; Quest&#245;es da vida adulta&#44; como sexualidade&#44; emprego&#44; independ&#234;ncia e manejo de c&#226;ncer de pele s&#227;o tratados com limita&#231;&#245;es&#44; o que torna necess&#225;rio o encaminhamento a outras especialidades&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">40</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#227;o</span><p id="par0210" class="elsevierStylePara elsevierViewall">Em doen&#231;as raras como a EB&#44; dados epidemiol&#243;gicos confi&#225;veis permitem a identifica&#231;&#227;o de tend&#234;ncias epidemiol&#243;gicas&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">14</span></a> Esse estudo demonstra a predomin&#226;ncia de formas mais graves na nossa casu&#237;stica &#40;EB distr&#243;fica&#41;&#44; provavelmente por se tratar de um hospital terci&#225;rio&#44; e ressalta a necessidade de cuidado multidisciplinar&#44; principalmente em rela&#231;&#227;o &#224;s comorbidades e &#224;s complica&#231;&#245;es dos pacientes&#44; como anemia&#44; doen&#231;as dent&#225;rias&#44; ortop&#233;dicas e do trato gastrointestinal e carcinoma espinocelular&#46; No Brasil&#44; h&#225; a necessidade de cria&#231;&#227;o de banco de dados que unifique informa&#231;&#245;es cl&#237;nicas de toda a popula&#231;&#227;o&#44; a fim de identificar essas tend&#234;ncias e permitir melhor direcionamento das pol&#237;ticas de sa&#250;de &#40;verbas e financiamento&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Suporte financeiro</span><p id="par0215" class="elsevierStylePara elsevierViewall">Estudo patrocinado pela Fundo de Apoio &#224; Dermatologia do Estado de S&#227;o Paulo &#40;FUNADERSP&#41; &#91;PROJETO 105&#8208;2022&#93; e pelo Departamento de Dermatologia do Hospital das Cl&#237;nicas da Universidade de S&#227;o Paulo&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Contribui&#231;&#227;o dos autores</span><p id="par0220" class="elsevierStylePara elsevierViewall">Chan I&#46; Thien&#58; concep&#231;&#227;o e planejamento do estudo&#59; coleta de dados ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; an&#225;lise estat&#237;stica&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Vanessa Rolim Bessa&#58; Coleta de dados&#44; ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; an&#225;lise estat&#237;stica&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Isadora Zago Miotto&#58; Coleta de dados&#44; ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; an&#225;lise estat&#237;stica&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Luciana Paula Samorano&#58; Concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Maria Cec&#237;lia Rivitti Machado&#58; Concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Zilda Najjar Prado de Oliveira&#58; Concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#59; an&#225;lise estat&#237;stica&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflito de interesses</span><p id="par0250" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Epiderm&#243;lise bolhosa &#40;EB&#41; &#233; um grupo de doen&#231;as heredit&#225;rias raras&#44; caracterizadas por fragilidade da pele e mucosas&#46; Dados epidemiol&#243;gicos de EB no Brasil s&#227;o escassos&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Descrever aspectos epidemiol&#243;gicos de pacientes com EB diagnosticados no Departamento de Dermatologia de um hospital terci&#225;rio&#44; de 2000 at&#233; 2022&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudo observacional e retrospectivo foi conduzido por meio da an&#225;lise de prontu&#225;rios&#46; Dados avaliados inclu&#237;ram forma cl&#237;nica&#44; sexo&#44; hist&#243;ria familiar&#44; consanguinidade&#44; idade ao diagn&#243;stico&#44; idade atual&#44; tempo de seguimento&#44; comorbidades&#44; exame histopatol&#243;gico e imunomapeamento&#44; presen&#231;a de nevos EB e de carcinomas espinocelulares &#40;CEC&#41;&#44; causa e idade da morte&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Dos 309 pacientes com EB heredit&#225;ria&#44; 278 foram inclu&#237;dos&#46; O tipo mais comum foi EB distr&#243;fica &#40;EBD&#41;&#44; com 73&#37; &#40;28&#44;4&#37; EBD dominante&#44; 31&#44;7&#37; EBD recessiva e 12&#44;9&#37; EBD pruriginosa&#41;&#46; Outros tipos foram juncional com 9&#44;4&#37;&#44; simples com 16&#44;5&#37; e Kindler com 1&#44;1&#37;&#46; Mulheres corresponderam a 53&#37; e homens a 47&#37;&#46; Hist&#243;ria familiar foi encontrada em 35&#37; e consanguinidade em 11&#37;&#46; A m&#233;dia de idade ao diagn&#243;stico foi de 10&#44;8 anos&#44; e da idade atual foi de 26 anos&#46; A m&#233;dia do tempo de seguimento foi de nove anos&#46; Estenose de es&#244;fago acometeu 14&#37;&#44; doen&#231;as dent&#225;rias acometeram 36&#37;&#44; desnutri&#231;&#227;o 13&#37; e anemia 29&#37; dos indiv&#237;duos&#46; Durante a investiga&#231;&#227;o diagn&#243;stica&#44; 72&#44;6&#37; realizaram exame histopatol&#243;gico e 92&#37; fizeram imunomapeamento&#46; Nevos EB foram identificados em 17&#37;&#46; Nove pacientes tiveram CEC&#46; Onze foram a &#243;bito&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Dados insuficientes nos prontu&#225;rios&#44; perda de seguimento e indisponibilidade do teste gen&#233;tico&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#245;es</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Neste estudo&#44; predominou EB distr&#243;fica e ressaltou&#8208;se a necessidade de cuidado multidisciplinar das comorbidades e das complica&#231;&#245;es&#46;</p></span>"
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          "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Epiderm&#243;lise bolhosa distr&#243;fica dominante &#40;EBDD&#41;&#46; &#40;A&#41; Forma generalizada acometendo o dorso&#46; A involu&#231;&#227;o das bolhas forma cicatrizes&#46; &#40;B&#41; P&#225;pulas escoriadas nos membros inferiores na EBD pruriginosa&#46;</p>"
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          "pt" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Imunomapeamento de epiderm&#243;lise bolhosa distr&#243;fica dominante &#40;EBDD&#41;&#46; Observar clivagem na subl&#226;mina densa&#44; com dep&#243;sito dos marcadores e fluoresc&#234;ncia no teto da bolha&#46; Os marcadores utilizados s&#227;o&#58; &#40;A&#41; Ant&#237;geno do penfigoide bolhoso&#44; &#40;B&#41; laminina&#44; &#40;C&#41; col&#225;geno IV e &#40;D&#41; col&#225;geno VII&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sexo</th><th class="td" title="\n
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                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Masc&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">Fem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&#227;o informado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EBS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EBJ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3522980.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Distribui&#231;&#227;o do tipo de epiderm&#243;lise bolhosa em rela&#231;&#227;o ao sexo&#44; ao hist&#243;rico familiar e &#224; consanguinidade</p>"
        ]
      ]
      8 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Tabela 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:2 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Idade ao diagn&#243;stico</th></tr><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">0 a 1 ano&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">1 a 10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">11 a 20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">21 a 30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">31 a 40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">41 a 50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">51 a 60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">61 a 70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">71 a 80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">81 a 90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EBS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EBJ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EBDD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#44;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EBDR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EBD pruriginosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EBK&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">103&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">278&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3522979.png"
              ]
            ]
            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="13" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Idade atual &#40;ou do &#243;bito&#41;</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">0 a 10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">11 a 20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">21 a 30&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">31 a 40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">41 a 50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">51 a 60&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">61 a 70&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">71 a 80&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">81 a 90&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">EBS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EBJ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EBDD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">EBD pruriginosa&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3522982.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Distribui&#231;&#227;o do tipo de epiderm&#243;lise bolhosa quanto &#224; idade ao diagn&#243;stico e quanto &#224; idade atual&#46; No caso de pacientes que foram a &#243;bito&#44; foi considerada a idade da morte</p>"
        ]
      ]
      9 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabela 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Comorbidades</th></tr><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estenose de es&#244;fago&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Altera&#231;&#227;o dent&#225;ria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Desnutri&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Anemia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Transfus&#227;o sangu&#237;nea&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Altera&#231;&#227;o ortop&#233;dica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Miopia &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Stafiloma da m&#225;cula &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Gastroenterol&#243;gicas</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estenose de es&#244;fago &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Megac&#243;lon &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;ndrome disp&#233;ptica &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Doen&#231;a do refluxo gastroesof&#225;gico &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Constipa&#231;&#227;o &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Otorrinolaringol&#243;gicas</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Otite &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rouquid&#227;o &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Discinesia far&#237;ngea &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hipoacusia &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Laringomal&#225;cia &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tumor do seio maxilar direito &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;ndrome da apneia e da hipopneia obstrutivas do sono &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Ortop&#233;dicas</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pseudosindactilia &#40;56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Malforma&#231;&#227;o &#243;ssea &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Osteomielite &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Deformidade articular &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Assimetria de membros inferiores &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Endocrinol&#243;gicas</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hipotireoidismo &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diabete <span class="elsevierStyleItalic">mellitus</span> &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Baixa estatura &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Osteoporose &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Puberdade tardia &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Puberdade precoce &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabete <span class="elsevierStyleItalic">mellitus</span> insulinodependente &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#243;dulo tireoideano &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hematol&#243;gicas</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anemia &#40;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tra&#231;o falc&#234;mico &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Defici&#234;ncia de G&#8208;6&#8208;PD &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mieloma m&#250;ltiplo &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P&#250;rpura trombocitop&#234;nica idiop&#225;tica &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Psiqui&#225;tricas</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Depress&#227;o &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Idea&#231;&#227;o suicida &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;ndrome do p&#226;nico &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Pneumol&#243;gicas</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Asma &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rinite al&#233;rgica &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estenose de traqueia &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Cardiol&#243;gicas</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hipertens&#227;o arterial &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cardiomiopatia dilatada &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Doen&#231;a de Chagas &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Angina &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cardiopatia &#40;CIA&#44; estenose a&#243;rtica e pulmonar&#41; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Urol&#243;gicas</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Infec&#231;&#227;o urin&#225;ria &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Criptorquidismo &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estenose uretral &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Nefrol&#243;gicas</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nefropatia &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nefrite por IgA &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "pt" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Outras manifesta&#231;&#245;es extracut&#226;neas encontradas nos pacientes deste estudo&#44; com o n&#250;mero de indiv&#237;duos acometidos entre par&#234;nteses</p>"
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                    0 => array:2 [
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Has"
                            1 => "J&#46;W&#46; Bauer"
                            2 => "C&#46; Bodemer"
                            3 => "M&#46;C&#46; Bolling"
                            4 => "L&#46; Bruckner-Tuderman"
                            5 => "A&#46; Diem"
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                        ]
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                      "Revista" => array:5 [
                        "tituloSerie" => "Br J Dermatol&#46;"
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                        "paginaFinal" => "627"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Bardhan"
                            1 => "L&#46; Bruckner-Tuderman"
                            2 => "I&#46;L&#46;C&#46; Chapple"
                            3 => "J&#46;D&#46; Fine"
                            4 => "N&#46; Harper"
                            5 => "C&#46; Has"
                          ]
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                  ]
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                    0 => array:2 [
                      "doi" => "10.1038/s41572-020-0210-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Rev Dis Primers&#46;"
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                        "volumen" => "6"
                        "paginaInicial" => "78"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An overview of the genetic basis of epidermolysis bullosa in Brazil&#58; discovery of novel and recurrent disease&#8208;causing variants"
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                          "etal" => false
                          "autores" => array:6 [
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                            1 => "J&#46;T&#46; Santin"
                            2 => "J&#46;A&#46; Frantz"
                            3 => "M&#46;J&#46;R&#46; Doriqui"
                            4 => "A&#46;E&#46; Kiszewski"
                            5 => "L&#46; Schuler-Faccini"
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                        "tituloSerie" => "Clin Genet&#46;"
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                        "paginaFinal" => "569"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Epidermolysis bullosa nevi&#58; clinical&#44; dermatoscopical and histological features in a case of recessive dystrofic form"
                      "autores" => array:1 [
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                            0 => "J&#46;N&#46; Melo"
                            1 => "P&#46;Y&#46; Teruya"
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                            3 => "N&#46;S&#46; Valente"
                            4 => "M&#46;N&#46; Sotto"
                            5 => "Z&#46;N&#46; Oliveira"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/s0365-05962011000400017"
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                        "volumen" => "86"
                        "paginaInicial" => "743"
                        "paginaFinal" => "746"
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                          0 => array:2 [
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                      "titulo" => "Underrecognition of epidermolysis bullosa pruriginosa"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;C&#46; Cha"
                            1 => "L&#46;P&#46; Samorano"
                            2 => "F&#46;M&#46; Dacache"
                            3 => "M&#46;C&#46; Rivitti-Machado"
                            4 => "Z&#46;N&#46;P&#46; de Oliveira"
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                  "host" => array:1 [
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                        "volumen" => "13"
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                        "paginaFinal" => "1038"
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                      "autores" => array:1 [
                        0 => array:2 [
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                            0 => "J&#46;D&#46; Fernandes"
                            1 => "M&#46;C&#46; Rivitti-Machado"
                            2 => "J&#46; Nakano"
                            3 => "B&#46; de Oliveira Rocha"
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                  "host" => array:1 [
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                      "titulo" => "Gene panel for the diagnosis of epidermolysis bullosa&#58; proposal for a viable and efficient approach"
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                          "etal" => false
                          "autores" => array:6 [
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                            2 => "J&#46;A&#46; Frantz"
                            3 => "M&#46; Siebert"
                            4 => "U&#46; Matte"
                            5 => "L&#46; Schuler-Faccini"
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                    ]
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                  "host" => array:1 [
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                      "Revista" => array:6 [
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                        "volumen" => "96"
                        "paginaInicial" => "155"
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                            3 => "R&#46;F&#46; Lellis"
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                    0 => array:1 [
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                        "tituloSerie" => "An Bras Dermatol&#46;"
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                        "paginaFinal" => "128"
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                  "contribucion" => array:1 [
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                      "titulo" => "Immunological mapping in hereditary epidermolysis bullosa"
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                          "etal" => false
                          "autores" => array:4 [
                            0 => "Z&#46;N&#46;P&#46; Oliveira"
                            1 => "A&#46;M&#46; P&#233;rigo"
                            2 => "L&#46;M&#46; Fukumori"
                            3 => "V&#46; Aoki"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/s0365-05962010000600012"
                      "Revista" => array:6 [
                        "tituloSerie" => "An Bras Dermatol&#46;"
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                        "volumen" => "85"
                        "paginaInicial" => "856"
                        "paginaFinal" => "861"
                        "link" => array:1 [
                          0 => array:2 [
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Genotype&#8208;phenotype correlations on epidermolysis bullosa with congenital absence of skin&#58; a comprehensive review"
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                            3 => "M&#46;J&#46;R&#46; Doriqui"
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                      "Revista" => array:6 [
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                        "paginaInicial" => "29"
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Informação do artigo

ISSN: 26662752
Idioma original: Português

DOI:10.1016/j.abdp.2024.02.015

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