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1.
J Med Primatol ; 53(1): e12685, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38009978

RESUMEN

BACKGROUND: The Vieira's titi monkey (Plecturocebus vieirai) was recently described and characterized as endemic to Brazil. According to the IUCN red list, this species is classified as critically endangered (CR). At the date of the publication of this manuscript, there are no published data on the health aspects of this species. METHODS: For this study, the necropsy, and histopathological data of the mortality of P. vieirai at Sorocaba Zoo (São Paulo, Brazil) were collected and analyzed. RESULTS: Causes of death diagnosed included disorders of the urinary, gastrointestinal, immune, and circulatory systems. CONCLUSIONS: This study provides information regarding the pathological conditions of P. vieirai and points to urinary and gastrointestinal diseases as the main causes of death in this species at Sorocaba Zoo. These results can help veterinarians who have this species under their care diagnose and deal with it more quickly, increasing the probability of survival.


Asunto(s)
Callicebus , Pitheciidae , Animales , Especies en Peligro de Extinción , Estudios Retrospectivos , Brasil/epidemiología
2.
J Med Primatol ; 53(3): e12713, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38802986

RESUMEN

A senile male black capuchin monkey (Sapajus nigritus) kept under human care in a Zoo was found dead after 2 weeks presenting signals of weight loss and hyporexia. Histopathological revealed a necrotizing encephalitis. Although it was not observed microscopically, Sarcocystis sp infection was detected in brain tissue from molecular assays. These infections have been rarely described in neotropical primates, particularly associated with tissue lesions.


Asunto(s)
Enfermedades de los Monos , Sarcocystis , Sarcocistosis , Animales , Sarcocistosis/veterinaria , Sarcocistosis/diagnóstico , Sarcocistosis/parasitología , Sarcocystis/aislamiento & purificación , Sarcocystis/genética , Enfermedades de los Monos/parasitología , Enfermedades de los Monos/diagnóstico , Masculino , Animales de Zoológico , Resultado Fatal , Encefalitis/veterinaria , Encefalitis/parasitología , Encefalitis/diagnóstico , Sapajus
3.
J Med Primatol ; 53(3): e12716, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38831476

RESUMEN

Neotropical primates rarely exhibit active tuberculosis. A brown howler monkey was found injured in an urban area. Histopathology revealed granulomatous inflammation in the lungs, lymph nodes, and liver. Immunohistochemistry and molecular analysis confirmed the presence of Mycobacterium tuberculosis complex. The findings highlight the importance of TB surveillance in nonhuman primates.


Asunto(s)
Alouatta , Enfermedades de los Monos , Mycobacterium tuberculosis , Tuberculosis , Animales , Enfermedades de los Monos/microbiología , Enfermedades de los Monos/patología , Brasil , Mycobacterium tuberculosis/aislamiento & purificación , Tuberculosis/veterinaria , Tuberculosis/microbiología , Tuberculosis/patología , Masculino , Femenino
4.
Genes Immun ; 24(2): 71-80, 2023 04.
Artículo en Inglés | MEDLINE | ID: mdl-36792680

RESUMEN

Ulcerative Colitis (UC) is an inflammatory disease characterized by colonic mucosal lesions associated with an increased risk of carcinogenesis. UC pathogenesis involves environmental and genetic factors. Genetic studies have indicated the association of gene variants coding for the divalent metal ion transporter SLC11A1 protein (formerly NRAMP1) with UC susceptibility in several animal species. Two mouse lines were genetically selected for high (AIRmax) or low (AIRmin) acute inflammatory responses (AIR). AIRmax is susceptible, and AIRmin is resistant to DSS-induced colitis and colon carcinogenesis. Furthermore, AIRmin mice present polymorphism of the Slc11a1 gene. Here we investigated the possible modulating effect of the Slc11a1 R and S variants in DSS-induced colitis by using AIRmin mice homozygous for Slc11a1 R (AIRminRR) or S (AIRminSS) alleles. We evaluated UC by the disease activity index (DAI), considering weight loss, diarrhea, blood in the anus or feces, cytokines, histopathology, and cell populations in the distal colon epithelium. AIRminSS mice have become susceptible to DSS effects, with higher DAI, IL6, G-CSF, and MCP-1 production and morphological and colon histopathological alterations than AIRminRR mice. The results point to a role of the Slc11a1 S allele in DSS colitis induction in the genetic background of AIRmin mice.


Asunto(s)
Colitis Ulcerosa , Colitis , Animales , Ratones , Carcinogénesis , Colitis/inducido químicamente , Colitis/genética , Colitis Ulcerosa/inducido químicamente , Colitis Ulcerosa/genética , Sulfato de Dextran/efectos adversos , Modelos Animales de Enfermedad , Susceptibilidad a Enfermedades , Inflamación/genética , Ratones Endogámicos C57BL , Polimorfismo Genético
5.
Emerg Infect Dis ; 29(12): 2541-2545, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37987590

RESUMEN

Opossums are considered resistant to rabies. Nonhematophagous bats are reservoirs of rabies in urban areas of South America. We analyzed bats and opossums tested for rabies during 2021 in a highly urbanized city in Brazil to understand spillover in an urban setting. Wildlife surveillance is necessary to prevent rabies in humans and domestic animals.


Asunto(s)
Didelphis , Rabia , Animales , Brasil/epidemiología , Quirópteros , Zarigüeyas , Rabia/epidemiología , Rabia/veterinaria
7.
J Appl Microbiol ; 134(1)2023 Jan 23.
Artículo en Inglés | MEDLINE | ID: mdl-36626744

RESUMEN

AIM: This work evaluated the microbial diversity and physicochemical characteristics of fresh and fermented fruits from Brazilian untreated green table olives of the Ascolano and Grappolo cultivars. METHODS AND RESULTS: Twenty species of mesophilic bacteria, seven lactic acid bacteria, and fourteen yeast were identified. Some species prevailed over others, such as the bacteria Levilactobacillus brevis, Lacticaseibacillus paracasei subsp. paracasei, Pantoea agglomerans, Staphylococcus warneri, Bacillus simplex, B. thuringiensis, and the yeasts Candida parapsilosis, Ca. orthopsilosis, and Cryptococcus flavescen. In the olive fruit and olive brine, the sugars: sucrose, glucose, mannitol, and fructose, and the acids: acetic, citric, lactic, malic, and succinic were identified. Thirty-seven volatile compounds belonging to different chemical classes of acids, alcohols, aldehydes, esters, hydrocarbons, phenols, ketones, and ether were identified in the fruits and brine olives. CONCLUSION: The polyphasic methodology using matrix assisted laser desorption/ionization-time of flight and 16S rRNA sequencing was efficiently performed to identify microorganisms; chemical analysis helped to understand the fermentation process of olives.


Asunto(s)
Olea , Olea/microbiología , Brasil , ARN Ribosómico 16S/genética , Levaduras/genética , Bacterias/genética , Saccharomyces cerevisiae/genética , Fermentación , Microbiología de Alimentos
8.
Conscious Cogn ; 108: 103462, 2023 02.
Artículo en Inglés | MEDLINE | ID: mdl-36621056

RESUMEN

The adaptive value of disgust has been associated with situations of threat to our survival. This study explored this topic using eye-tracking, which provides an objective measurement of attention, while solving previous methodological issues (e.g., not considering discrete emotions and comparing across perceptually-different stimuli). We used the same stimuli and manipulated the emotional state via contextual framing. Participants' eye movements and pupillary responses were recorded while they explored pictures of objects held by clean or dirty hands; the latter were framed in a disease or a non-disease context. Pictures were then rated for arousal, disgust, and valence. Framing stimuli in a disease (vs non-disease) context induced a more adverse subjective emotional experience. Importantly, our objective measures revealed that such manipulation also led to a higher information-seeking behavior and greater pupil constriction. Overall, our data suggest that the same stimuli can effectively be used to induce different emotional states by manipulating their framing.


Asunto(s)
Asco , Humanos , Movimientos Oculares , Emociones/fisiología , Atención/fisiología , Nivel de Alerta/fisiología
9.
Appl Microbiol Biotechnol ; 107(24): 7621-7633, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37819395

RESUMEN

Biosurfactants (BS) are becoming a solution for today's world since they are considered a reasonable and eco-friendly option for use in products that require surfactants. This study aimed to evaluate the antibacterial activity of purified fractions containing biosurfactants produced by the yeast Wickerhamomyces anomalus CCMA 0358 using waste cooking oil (WCO) as substrate. Mixed fractions were separated and characterized by TLC, MPLC, GC-MS, LC-OMS, LC-SQMS, FTIR, 1H, 13C, DEPT 135, COSY, HSQC, and HMBC. The results confirmed the presence of palmitic acid and oleic acid fatty acids, derived from the core biosurfactant structure; however, the core could not be identified. The crude biosurfactant and its purified fractions were evaluated against pathogenic bacteria, and the purified fractions of the biosurfactant are more efficient at inhibitory and bactericidal activities than the crude biosurfactant. To the best of our knowledge, this is the first study that evaluated the antimicrobial activity of purified fractions of biosurfactants produced by the species Wickerhamomyces anomalus. Therefore, the purification of biosurfactants can emerge as an interesting alternative to increase the bioactivity of the compounds and ensure greater efficiency and biotechnological employability. KEY POINTS: • Successful production of a biosurfactant using a renewed carbon source. • Evaluation of the antimicrobial activity of purified fractions of BS. • Separated fractions of the BS are more efficient against bacteria than the crude BS.


Asunto(s)
Saccharomycetales , Bacterias , Ácidos Grasos , Tensoactivos/farmacología , Tensoactivos/química , Antibacterianos/farmacología
10.
PLoS Pathog ; 16(8): e1008699, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32764827

RESUMEN

São Paulo, a densely inhabited state in southeast Brazil that contains the fourth most populated city in the world, recently experienced its largest yellow fever virus (YFV) outbreak in decades. YFV does not normally circulate extensively in São Paulo, so most people were unvaccinated when the outbreak began. Surveillance in non-human primates (NHPs) is important for determining the magnitude and geographic extent of an epizootic, thereby helping to evaluate the risk of YFV spillover to humans. Data from infected NHPs can give more accurate insights into YFV spread than when using data from human cases alone. To contextualise human cases, identify epizootic foci and uncover the rate and direction of YFV spread in São Paulo, we generated and analysed virus genomic data and epizootic case data from NHPs in São Paulo. We report the occurrence of three spatiotemporally distinct phases of the outbreak in São Paulo prior to February 2018. We generated 51 new virus genomes from YFV positive cases identified in 23 different municipalities in São Paulo, mostly sampled from NHPs between October 2016 and January 2018. Although we observe substantial heterogeneity in lineage dispersal velocities between phylogenetic branches, continuous phylogeographic analyses of generated YFV genomes suggest that YFV lineages spread in São Paulo at a mean rate of approximately 1km per day during all phases of the outbreak. Viral lineages from the first epizootic phase in northern São Paulo subsequently dispersed towards the south of the state to cause the second and third epizootic phases there. This alters our understanding of how YFV was introduced into the densely populated south of São Paulo state. Our results shed light on the sylvatic transmission of YFV in highly fragmented forested regions in São Paulo state and highlight the importance of continued surveillance of zoonotic pathogens in sentinel species.


Asunto(s)
Genoma Viral , Enfermedades de los Primates/virología , Fiebre Amarilla/veterinaria , Fiebre Amarilla/virología , Virus de la Fiebre Amarilla/genética , Zoonosis/virología , Animales , Brasil/epidemiología , Brotes de Enfermedades , Genómica , Humanos , Filogenia , Filogeografía , Enfermedades de los Primates/epidemiología , Enfermedades de los Primates/transmisión , Primates/virología , Fiebre Amarilla/epidemiología , Fiebre Amarilla/transmisión , Virus de la Fiebre Amarilla/clasificación , Virus de la Fiebre Amarilla/aislamiento & purificación , Zoonosis/epidemiología , Zoonosis/transmisión
11.
J Med Primatol ; 51(6): 384-387, 2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-35614847

RESUMEN

Keeping Neotropical primates in captivity puts them at great risk of illness because of their susceptibility to human herpesvirus. This is the first report on herpesvirus in Callicebus nigrifrons that developed clinical disease and was confirmed by immunohistochemical and RT-PCR. Diagnosis and prevention are essential for the conservation of species.


Asunto(s)
Pitheciidae , Humanos , Animales , Primates
12.
Dis Aquat Organ ; 148: 13-18, 2022 Feb 10.
Artículo en Inglés | MEDLINE | ID: mdl-35142294

RESUMEN

Histopathological and immunohistochemical methods were used to diagnose round cell tumors in 2 subantarctic fur seals Arctocephalus tropicalis with marked anemia. Although wild-born, both individuals were placed under human care while juveniles in a Brazilian aquarium. Both pinnipeds were PCR tested for herpesvirus, and 1 was infected with otariid gammaherpesvirus 5 (OtHV-5), previously described in a subantarctic fur seal stranded in Brazil. Although some gammaherpesviruses can cause sarcomas and other neoplasms, it was not possible to definitively associate OtHV-5 with the neoplasm. To our knowledge, these are the first neoplasm records in subantarctic fur seals.


Asunto(s)
Caniformia , Lobos Marinos , Herpesviridae , Sarcoma Histiocítico , Animales , Brasil/epidemiología , Sarcoma Histiocítico/veterinaria
13.
BMC Nurs ; 21(1): 233, 2022 Aug 23.
Artículo en Inglés | MEDLINE | ID: mdl-35999542

RESUMEN

BACKGROUND: The Quality of Life in climacteric women is intrinsically related to signs and symptoms influenced by the decrease of estrogen and psychosocial factors linked to the natural aging process. Thus, this study aimed to trace the sociodemographic and clinical profiles of climacteric women working at the State University of Rio Grande do Norte (UERN) and evaluate their Quality of Life. METHODS: It is a descriptive, exploratory, and quantitative study. The population consisted of female workers from UERN, aging between 40 and 65 years. The total sample consisted of 63 women who answered the forms. Data collection was completely online, which allowed the women to have free choice to choose the most appropriate time to answer the questions. RESULTS: The majority of the participants were older than 50 years (53.97%, n = 34), were married or in a stable union (55.56%, n = 35), and lived in Mossoró-RN (82.53%, n = 52). Regarding skin color, white and brown women had the same percentage of 44.44% (n = 28). The pain, general health status, and vitality domains evidence the predominance of poor quality of life in the SF-36 questionnaire. Regarding the level of satisfaction with their current health status, 4.76% (n = 3) stated that they fit the level considered excellent, 44.44% (n = 28) very good, 46, 03% (n = 29) were good, and 4.77% (n = 3) stated unsatisfied with their current health status. The intensity of symptoms related to estrogen deficiency established by the Kupperman menopause index is as Mild 55.56% (n = 35), moderate 41.27% (n = 26), and severe 3.17% (n = 2). CONCLUSIONS: The occurrence of symptoms and perception of these symptoms differs from woman to woman, to a greater or lesser extent. These findings emphasize the need for qualified and individualized care for the needs of these women in health services and the development of applicable solutions for solving problems based on each woman profile.

14.
Emerg Infect Dis ; 27(1): 47-56, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33350931

RESUMEN

A major outbreak of yellow fever (YF) occurred in Brazil during 2016-2018. Epizootics in New World nonhuman primates are sentinel events for YF virus circulation. However, genus-specific susceptibilities and suitability for YF surveillance remain poorly understood. We obtained and compared epidemiologic, histopathologic, immunohistochemical, and molecular results from 93 human and 1,752 primate cases submitted during the recent YF outbreak in Brazil (2017), with the support of the Brazilian National YF Surveillance Program. We detected heterogeneous YF-associated profiles among the various genera of primates we analyzed. Alouatta primates were the most reliable sentinel; Sapajus and Callicebus primates had higher viral loads but lower proportional mortality rates. Callithrix primates were the least sensitive, showing lower viral loads, lower proportional mortality rates, and no demonstrable YF virus antigen or extensive lesions in liver, despite detectable viral RNA. These differences in susceptibility, viral load, and mortality rates should be considered in strategic surveillance of epizootics and control measures for YF.


Asunto(s)
Alouatta , Fiebre Amarilla , Animales , Brasil/epidemiología , Humanos , Primates , Fiebre Amarilla/epidemiología , Fiebre Amarilla/veterinaria , Virus de la Fiebre Amarilla/genética
16.
Vet Pathol ; 58(4): 730-735, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-33955292

RESUMEN

From 2016 to 2018, an epidemic wave of yellow fever (YF) occurred in Brazil, affecting a large number of Platyrrhini monkeys. Titi monkeys (Callicebus spp.) were severely affected yet pathological characterizations are lacking. This study characterized epizootic YF in 43 titi monkeys (Callicebus spp.) with respect to the microscopic lesions in liver, kidney, spleen, heart, brain, and lung, as well as the distribution of immunolabeling for YF virus antigen, and the flaviviral load in the liver. Of 43 titi monkeys examined, 18 (42%) were positive for yellow fever virus (YFV) by immunohistochemistry or reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR). Affected livers had consistent marked panlobular necrotizing hepatitis, lipidosis, and mild inflammation, with intense immunolabeling for YFV mainly in centrilobular hepatocytes (zone 1; P = .05). In the spleen, consistent findings were variable lymphoid depletion (10/11), lymphoid necrosis (lymphocytolysis; 4/11), and immunolabeling for YFV in histiocytic cells (3/16). The main finding in the kidney was multifocal acute necrosis of tubular epithelium (5/7) that was occasionally associated with intracytoplasmic immunolabeling for YFV (6/15). These data indicate that titi monkeys are susceptible to YFV infection, developing severe hepatic lesions and high viral loads, comparable to humans and Alouatta spp. Thus, Callicebus spp. may be reliable sentinels for YF surveillance.


Asunto(s)
Alouatta , Fiebre Amarilla , Animales , Callicebus , Causas de Muerte , Fiebre Amarilla/veterinaria , Virus de la Fiebre Amarilla
17.
J Card Surg ; 36(4): 1376-1380, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33567123

RESUMEN

INTRODUCTION: Elevated neutrophil-lymphocyte ratio (NLR) has been associated with poorer outcomes in children undergoing congenital heart surgery under cardiopulmonary bypass (CPB). OBJECTIVE: To compare preoperative NLR levels between cyanotic and acyanotic children undergoing surgical repair with CPB. METHODS: We performed a retrospective cohort study in 60-paired children (30 with tetralogy of Fallot [TOF] and 30 with ventricular septal defect [VSD]) between January 2018 and December 2019 matched by age, weight, and gender. Preoperative NLR was measured from the last complete blood count test before the surgery. All of them had negative viral screening. RESULTS: The median age in VSD children was 9.5 months (interquartile range [IQR]: 5-12), weight 7 kg (IQR: 5.5-8.7), 19 (63%) was female, and NLR was 0.45 (IQR: 0.3-0.65). The median age in TOF children was 8.5 months (IQR: 5-12), weight 7.6 kg (IQR: 5.8-8.7), 16 (53%) were female, and NLR was 0.67 (IQR: 0.41-1.1). Demographic parameters did not show any statistically significant difference between groups (p > .05). Children with TOF had higher preoperative NLR compared with VSD patients (p = .004). As lower O2 saturation as higher the NLR (p = .005). CONCLUSION: The preoperative level of NLR was higher in cyanotic congenital heart disease patients.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Cardiopatías Congénitas , Niño , Femenino , Cardiopatías Congénitas/cirugía , Humanos , Lactante , Linfocitos , Masculino , Neutrófilos , Estudios Retrospectivos
18.
Cardiol Young ; 31(6): 1009-1014, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-34016219

RESUMEN

INTRODUCTION: Acute kidney injury is a risk factor for chronic kidney disease and mortality after congenital heart surgery under cardiopulmonary bypass. The neutrophil-lymphocyte ratio is an inexpensive and easy to measure biomarker for predicting outcomes in children with congenital heart disease undergoing surgical correction. OBJECTIVE: To identify children at high risk of acute kidney injury after tetralogy of Fallot repair using the neutrophil-lymphocyte ratio. METHODS: This single-centre retrospective analysis included consecutive patients aged < 18 years who underwent tetralogy of Fallot repair between January 2014 and December 2018. The pre-operative neutrophil-lymphocyte ratio was measured using the last pre-operative complete blood count test. We used the Acute Kidney Injury Network definition. RESULTS: A total of 116 patients were included, of whom 39 (33.6%) presented with acute kidney injury: 20 (51.3%) had grade I acute kidney injury, nine had grade II acute kidney injury (23.1%), and 10 (25.6%) had grade III acute kidney injury. A high pre-operative neutrophil-lymphocyte ratio was associated with grade III acute kidney injury in the post-operative period (p = 0.04). Patients with acute kidney injury had longer mechanical ventilation time (p = 0.023), intensive care unit stay (p < 0.001), and hospital length of stay (p = 0.002). CONCLUSION: Our results suggest that the pre-operative neutrophil-lymphocyte ratio can be used to identify patients at risk of developing grade III acute kidney injury after tetralogy of Fallot repair.


Asunto(s)
Lesión Renal Aguda , Tetralogía de Fallot , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , Niño , Humanos , Lactante , Linfocitos , Neutrófilos , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Medición de Riesgo , Tetralogía de Fallot/cirugía
19.
Emerg Infect Dis ; 26(12): 3039-3043, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33219810

RESUMEN

After the sudden death of captive marmosets in São Paulo, Brazil, we conducted a histologic and microbiologic study. We found hyperacute septicemia caused by hypermucoviscous sequence type 86 K2 Klebsiella pneumoniae. We implemented prophylactic antimicrobial therapy, selected dedicated staff for marmoset interactions, and sanitized the animals' fruit to successfully control this outbreak.


Asunto(s)
Infecciones por Klebsiella , Klebsiella pneumoniae , Animales , Brasil/epidemiología , Callithrix , Brotes de Enfermedades , Infecciones por Klebsiella/epidemiología , Infecciones por Klebsiella/veterinaria , Klebsiella pneumoniae/genética , Virulencia , beta-Lactamasas
20.
J Med Primatol ; 49(2): 65-70, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31885097

RESUMEN

BACKGROUND: Non-human primates (NHPs) are susceptible to dogs' attacks, events that may cause muscle damage along with stress, and could be in some extent compatible with capture myopathy, a syndrome that results in myoglobinuria and renal damage. METHODS: We aimed to evaluate by histopathology pre-existing lesions and subsequent sequelae related to dogs' attacks, acute tubular necrosis (ATN) and myoglobinuria, as well as the usefulness of Pearls Stain and IHC to diagnose it. Histopathology was performed in available organs, and sections of kidney submitted to Prussian blue stain and myoglobin immunohistochemistry. RESULTS: During January 2014-June 2016, 16/145 (11%) of NHPs received by Adolfo Lutz Institute, Brazil were reported as attacked by dogs. A high frequency of young and debilitated animals was found. Myoglobinuria was observed in more than half animals (9/16; 56.2%), from which (5/9; 55.5%) presented ATN. CONCLUSIONS: Kidney lesions are plausible findings in NHPs attacked by dogs.


Asunto(s)
Alouatta , Mordeduras y Picaduras/veterinaria , Callithrix , Necrosis Tubular Aguda/veterinaria , Enfermedades de los Monos/patología , Mioglobinuria/veterinaria , Factores de Edad , Animales , Mordeduras y Picaduras/patología , Mordeduras y Picaduras/fisiopatología , Brasil , Perros , Femenino , Riñón/patología , Necrosis Tubular Aguda/diagnóstico , Necrosis Tubular Aguda/patología , Masculino , Enfermedades de los Monos/diagnóstico , Mioglobinuria/diagnóstico , Mioglobinuria/patología , Factores Sexuales
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