Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 11 de 11
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Toxicology ; 359-360: 19-28, 2016 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-27330022

RESUMO

Human exposure to multiple pyrethroid insecticides may occur because of their broad use on crops and for residential pest control. To address the potential health risk from co-exposure to pyrethroids, it is important to understand their disposition and toxicity in target organs such as the brain, and surrogates such as the blood when administered as a mixture. The objective of this study was to assess the correlation between blood and brain concentrations of pyrethroids and neurobehavioral effects in the rat following an acute oral administration of the pyrethroids as a mixture. Male Long-Evans rats were administered a mixture of ß-cyfluthrin, cypermethrin, deltamethrin, esfenvalerate and cis- and trans-permethrin in corn oil at seven dose levels. The pyrethroid with the highest percentage in the dosing solution was trans-permethrin (31% of total mixture dose) while deltamethrin and esfenvalerate had the lowest percentage (3%). Motor activity of the rats was then monitored for 1h. At 3.5h post-dosing, the animals were euthanized and blood and brain were collected. These tissues were extracted and analyzed for parent pyrethroid using HPLC-tandem mass spectrometry. Cypermethrin and cis-permethrin were the predominate pyrethroids detected in blood and brain, respectively, at all dosage levels. The relationship of total pyrethroid concentration between blood and brain was linear (r=0.93). The pyrethroids with the lowest fraction in blood were trans-permethrin and ß-cyfluthrin and in brain were deltamethrin and esfenvalerate. The relationship between motor activity of the treated rats and summed pyrethroid blood and brain concentration was described using a sigmoidal Emax model with the Effective Concentration50 being more sensitive for brain than blood. The data suggests summed pyrethroid rat blood concentration could be used as a surrogate for brain concentration as an aid to study the neurotoxic effects of pyrethroids administered as a mixture under the conditions used in this study.


Assuntos
Encéfalo/metabolismo , Inseticidas , Atividade Motora/efeitos dos fármacos , Piretrinas , Animais , Interações Medicamentosas , Inseticidas/sangue , Inseticidas/farmacocinética , Inseticidas/toxicidade , Masculino , Piretrinas/sangue , Piretrinas/farmacocinética , Piretrinas/toxicidade , Ratos , Ratos Long-Evans
2.
Toxicology ; 320: 15-24, 2014 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-24631210

RESUMO

UNLABELLED: National surveys of United States households and child care centers have demonstrated that pyrethroids are widely distributed in indoor habited dwellings and this suggests that co-exposure to multiple pyrethroids occurs in nonoccupational settings. The purpose of this research was to use an environmentally relevant mixture of pyrethroids to assess their cumulative effect on motor activity and develop kinetic profiles for these pyrethroids and their hydrolytic metabolites in brain and blood of rats. Rats were dosed orally at one of two levels (1.5× or 5.0× the calculated dose that decreases rat motor activity by 30%) with a mixture of cypermethrin, deltamethrin, esfenvalerate, cis-/trans-permethrin, and ß-cyfluthrin in corn oil. At 1, 2, 4, 8, or 24h after dosing, the motor activity of each animal was assessed and the animals sacrificed. Concentrations of pyrethroids in brain and blood, and the following metabolites: cis-/trans-dichlorovinyl-dimethylcyclopropane-carboxylic acid, 3-phenoxybenzoic acid, 3-phenoxybenzyl alcohol, 4-fluoro-3-phenoxybenzoic acid, and cis-dibromovinyl-dimethylcyclopropane-carboxylic acid were determined using liquid chromatography tandem mass spectrometry (LC-MS/MS). Using this pyrethroid mixture in rats, the results suggest there is greater metabolism of trans-permethrin prior to entering the systemic circulatory system. All pyrethroids had tissue half-lives (t1/2) of less than 5h, excepting esfenvalerate in brain. At early time points, relative pyrethroid brain concentrations approximated their dose mixture proportions and a sigmoidal Emax model described the relationship between motor activity decrease and total pyrethroid brain concentration. In blood, the t1/2's of the cyclopropane metabolites were longer than the phenoxybenzoic metabolites. However, relative to their respective precursors, concentrations of the phenoxybenzoic acids were much higher than concentrations of the cyclopropane metabolites. Brain concentrations of all metabolites were low relative to blood concentrations. This implies limited metabolite penetration of the blood-brain barrier and little metabolite formation within the brain. IN CONCLUSION: toxicokinetic differences between the pyrethroids did not appear to be important determinants of their relative potency and their effect on motor activity was consistent with a pyrethroid dose additive model.


Assuntos
Barreira Hematoencefálica/metabolismo , Encéfalo/metabolismo , Inseticidas/toxicidade , Atividade Motora/efeitos dos fármacos , Piretrinas/toxicidade , Administração Oral , Animais , Cromatografia Líquida , Relação Dose-Resposta a Droga , Exposição Ambiental/efeitos adversos , Meia-Vida , Inseticidas/administração & dosagem , Inseticidas/farmacocinética , Masculino , Modelos Biológicos , Piretrinas/administração & dosagem , Piretrinas/farmacocinética , Ratos , Ratos Long-Evans , Espectrometria de Massas em Tandem , Fatores de Tempo , Distribuição Tecidual
3.
Toxicol Sci ; 130(1): 33-47, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22859315

RESUMO

Permethrin is a broad-spectrum pyrethroid insecticide and among the most widely used insecticides in homes and crops. Managing the risks for pesticides such as permethrin depends on the ability to consider diverse exposure scenarios and their relative risks. Physiologically based pharmacokinetic models of delta methrin disposition were modified to describe permethrin kinetics in the rat and human. Unlike formulated deltamethrin which consists of a single stereoisomer, permethrin is formulated as a blend of cis- and trans-diastereomers. We assessed time courses for cis-permethrin and trans-permethrin in several tissues (brain, blood, liver, and fat) in the rat following oral administration of 1 and 10mg/kg permethrin (cis/trans: 40/60). Accurate simulation of permethrin in the rat suggests that a generic model structure is promising for modeling pyrethroids. Human in vitro data and appropriate anatomical information were used to develop a provisional model of permethrin disposition with structures for managing oral, dermal, and inhalation routes of exposure. The human permethrin model was used to evaluate dietary and residential exposures in the U.S. population as estimated by EPA's Stochastic Human Exposure and Dose Simulation model. Simulated cis- and trans-DCCA, metabolites of permethrin, were consistent with measured values in the National Health and Nutrition Examination Survey, indicating that the model holds promise for assessing population exposures and quantifying dose metrics.


Assuntos
Exposição Ambiental , Contaminação de Alimentos , Inseticidas/farmacocinética , Modelos Biológicos , Permetrina/farmacocinética , Animais , Dieta , Vias de Administração de Medicamentos , Contaminação de Alimentos/análise , Humanos , Inseticidas/administração & dosagem , Isomerismo , Masculino , Microssomos Hepáticos/efeitos dos fármacos , Microssomos Hepáticos/metabolismo , Permetrina/administração & dosagem , Ratos , Ratos Long-Evans , Fluxo Sanguíneo Regional , Medição de Risco , Distribuição Tecidual
4.
Toxicol Sci ; 130(2): 309-18, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22872056

RESUMO

Due to extensive use, human exposure to multiple pyrethroid insecticides occurs frequently. Studies of pyrethroid neurotoxicity suggest a common mode of toxicity and that pyrethroids should be considered cumulatively to model risk. The objective of this work was to use a pyrethroid mixture that reflects human exposure to common pyrethroids to develop comparative toxicokinetic profiles in rats, and then model the relationship between brain concentration and motor activity. Data from a national survey of child care centers were used to make a mixture reflecting proportions of the most prevalent pyrethroids: permethrin, cypermethrin, ß-cyfluthrin, deltamethrin, and esfenvalerate. The mixture was administered orally at one of two concentrations (11.2 and 27.4 mg/kg) to adult male rats. At intervals from 1 to 24h, motor activity was assessed and the animals were sacrificed. Pyrethroid concentrations were measured in the blood, liver, fat, and brain. After controlling for dose, there were no differences in any tissue concentrations, except blood at the initial time point. Elimination half-lives for all pyrethroids in all tissues were < 7h. Brain concentrations of all pyrethroids (when cis- and trans-permethrin were pooled) at the initial time point were proportional to their relative doses. Decreases in motor activity indicated dose additivity, and the relationship between pyrethroid brain concentration and motor activity was described by a four-parameter sigmoidal E(max) model. This study links environmental data with toxicokinetic and neurobehavioral assays to support cumulative risk assessments of pyrethroid pesticides. The results support the additive model of pyrethroid effect on motor activity and suggest that variation in the neurotoxicity of individual pyrethroids is related to toxicodynamic rather than toxicokinetic differences.


Assuntos
Comportamento Animal/efeitos dos fármacos , Encéfalo/efeitos dos fármacos , Poluentes Ambientais/toxicidade , Inseticidas/toxicidade , Atividade Motora/efeitos dos fármacos , Síndromes Neurotóxicas/etiologia , Piretrinas/toxicidade , Tecido Adiposo/metabolismo , Animais , Carga Corporal (Radioterapia) , Encéfalo/metabolismo , Relação Dose-Resposta a Droga , Monitoramento Ambiental , Poluentes Ambientais/sangue , Poluentes Ambientais/farmacocinética , Meia-Vida , Inseticidas/sangue , Inseticidas/farmacocinética , Limite de Detecção , Fígado/metabolismo , Masculino , Modelos Animais , Modelos Biológicos , Síndromes Neurotóxicas/metabolismo , Síndromes Neurotóxicas/psicologia , Piretrinas/sangue , Piretrinas/farmacocinética , Ratos , Ratos Long-Evans , Reprodutibilidade dos Testes , Medição de Risco , Distribuição Tecidual
5.
Environ Toxicol Chem ; 31(2): 336-46, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22045600

RESUMO

This study evaluated the interactions of flight, fasting, and 1,1,1-trichloro-bis(4-chlorophenyl)ethane (p,p'-DDT) loading on residue metabolism and distribution in recently exposed white-crowned sparrows (Zonotrichia leucophrys). Female sparrows were dosed with 5 mg p,p'-DDT per kg body weight over 3 d. Following 1 d of recovery, sparrows were flown in a wind tunnel for up to 140 min, in 15-min blocks. Food was withheld from the start of the flight period until birds were euthanized. DDT, 1,1-dichloro-2,2-bis(4 chlorophenyl)ethane (DDD), and 1,1-dichloro-2,2-bis(4-chlorophenyl)ethylene (DDE) were present in all tissues examined. 1-Chloro-2,2-bis(4-chlorophenyl)ethene (DDµ), 1,1-bis(4-chlorophenyl)ethane (p,p'-DDη), and 2,2-bis(4-chlorophenyl)ethanol (p,p'-DDOH) were not found. Fasting did not significantly affect the rate of residue increase over time in any of the tissues examined. When sparrows flew and fasted simultaneously, fasting seldom contributed to an increase in tissue residues. However, the length of time flown was significantly correlated with increasing toxicant concentrations in the brain, kidney, and liver, effectively demonstrating the potential for brief flights to enhance mobilization of DDT and its metabolites. Dose, flight, and fasting also increased residues in brain tissue. These contaminant redistributions may have important ramifications on the stresses experienced by migratory birds.


Assuntos
DDT/metabolismo , Poluentes Ambientais/metabolismo , Pardais/metabolismo , Animais , DDT/análogos & derivados , Diclorodifenil Dicloroetileno/metabolismo , Diclorodifenildicloroetano/metabolismo , Monitoramento Ambiental , Jejum/metabolismo , Feminino , Humanos , Masculino
6.
Toxicology ; 290(1): 1-6, 2011 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-21854826

RESUMO

The potential for human exposure to pyrethroid pesticides has prompted pharmacodynamic and pharmacokinetic research to better characterize risk. This work tested the hypothesis that blood and brain concentrations of the pyrethroid bifenthrin are predictive of neurotoxic effects. Adult male Long Evans rats received a single oral dose of bifenthrin dissolved in corn oil. Using figure-eight mazes, motor activity was measured for 1h at 4- and 7-h following exposure to bifenthrin (0-16mg/kg or 0-9mg/kg, respectively; n=4-8/group). Whole blood and brains were collected immediately following motor activity assays. Bifenthrin concentrations in blood and brain were quantified using HPLC/MS/MS. Bifenthrin exposure decreased motor activity from 20% to 70% in a dose-dependent manner at both time points. The relationship between motor activity data and administered dose, and blood and brain bifenthrin concentrations were described using a sigmoidal E(max) model. The relationships between motor activity and administered dose or blood concentrations were different between the 4- and 7-h time points. The relationship between motor activity and brain concentration was not significantly different between the two time points. These data suggest that momentary brain concentration of bifenthrin may be a more precise dose metric for predicting behavioral effects because the relationship between brain concentration and locomotor activity is independent of the time of exposure.


Assuntos
Encéfalo/metabolismo , Piretrinas/metabolismo , Piretrinas/toxicidade , Animais , Encéfalo/efeitos dos fármacos , Inseticidas/sangue , Inseticidas/metabolismo , Inseticidas/toxicidade , Masculino , Atividade Motora/efeitos dos fármacos , Atividade Motora/fisiologia , Piretrinas/sangue , Ratos , Ratos Long-Evans , Distribuição Tecidual/efeitos dos fármacos , Distribuição Tecidual/fisiologia
7.
Toxicol Sci ; 115(2): 330-43, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20200215

RESUMO

Mirfazaelian et al. developed a physiologically based pharmacokinetic (PBPK) model for the pyrethroid pesticide deltamethrin in the rat. This model describes gastrointestinal (GI) tract absorption as a saturable process mediated by phase III efflux transporters which pump deltamethrin out of the intestinal enterocytes into the GI tract lumen, resulting in minimal net absorption at low concentrations and increasing absorption at higher concentrations. In the present study, the dose dependency in absorption of deltamethrin was examined in male Long Evans rats using po exposures predicted by the Mirfazaelian model to yield different po bioavailability values. No difference in the bioavailability from single po doses of 0.3 and 3.0 mg/kg deltamethrin was observed. Based on this finding, the Mirfazaelian PBPK model was modified to exclude a saturable absorption process. Other changes to the Mirfazaelian model included describing all tissue compartments with diffusion-limited kinetics and a single blood compartment. These changes improved model predictions of deltamethrin tissue concentration data from the present study and the literature. The rat model was then scaled to humans. The model predicted a twofold greater peak deltamethrin brain concentration and threefold greater area under the curve (AUC(0-48 h)) for humans following an po exposure of 1 mg/kg. Based on this model, humans would have greater distribution of deltamethrin to the brain for the same administered po dose compared to rats. The relative sensitivity to deltamethrin between rats and humans depends on both pharmacokinetic and pharmacodynamic differences. Species differences in the pharmacodynamic responses to deltamethrin between rats and humans remain uncharacterized.


Assuntos
Inseticidas/farmacocinética , Nitrilas/farmacocinética , Piretrinas/farmacocinética , Administração Oral , Animais , Relação Dose-Resposta a Droga , Enterócitos/efeitos dos fármacos , Enterócitos/metabolismo , Humanos , Absorção Intestinal/efeitos dos fármacos , Absorção Intestinal/fisiologia , Masculino , Modelos Biológicos , Ratos , Ratos Long-Evans , Especificidade da Espécie
8.
Drug Metab Dispos ; 37(1): 221-8, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18948380

RESUMO

Species differences in the intrinsic clearance (CL(int)) and the enzymes involved in the metabolism of pyrethroid pesticides were examined in rat and human hepatic microsomes. The pyrethroids bifenthrin, S-bioallethrin, bioresmethrin, beta-cyfluthrin, cypermethrin, cis-permethrin, and trans-permethrin were incubated in rat and human hepatic microsomes in the presence or absence of NADPH. Metabolism was measured using a parent depletion approach. The CL(int) of the pyrethroids was 5- to 15-fold greater in rat relative to human microsomes except for trans-permethrin, which was approximately 45% greater in human microsomes. The metabolism of bifenthrin, S-bioallethrin, and cis-permethrin in rat and human hepatic microsomes was solely the result of oxidative processes. The metabolism of bioresmethrin and cypermethrin in human hepatic microsomes was solely the result of hydrolytic processes. Bioresmethrin and cypermethrin in rat hepatic microsomes and beta-cyfluthrin and trans-permethrin in microsomes from both species were metabolized by both oxidative and hydrolytic pathways. The metabolism of trans-permethrin was reduced when incubated with its diastereomer, cis-permethrin, in both rat and human hepatic microsomes. Rat cytochrome P450 (P450) isoforms that showed activity toward several pyrethroids included CYP1A1, CYP1A2, CYP2C6, CYP2C11, CYP3A1, and CYP3A2. Human P450 isoforms that showed activity toward multiple pyrethroids were CYP2C8, CYP2C9, CYP2C19, and CYP3A4. Species-specific differences in metabolism may result in variable detoxification of pyrethroids, which may in turn result in divergent neurotoxic outcomes. These species differences and isomer interactions in metabolism of pyrethroids should be considered when assessing the potential adverse health effects of pyrethroid pesticides.


Assuntos
Sistema Enzimático do Citocromo P-450/metabolismo , Isoenzimas/metabolismo , Microssomos Hepáticos/metabolismo , Praguicidas/metabolismo , Piretrinas/metabolismo , Animais , Humanos , Masculino , Microssomos Hepáticos/enzimologia , Ratos , Ratos Long-Evans
9.
Drug Metab Dispos ; 35(9): 1664-71, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17576809

RESUMO

The metabolism of (alphaS)-cyano-3-phenoxybenzyl (1R, 3R)-cis-3-(2,2-dibromovinyl)-2,2-dimethylcyclopropane carboxylate (deltamethrin) and (alphaS)-cyano-3-phenoxybenzyl 2-(4-chlorophenyl)-3-methylbutyrate (esfenvalerate) by rat and human liver microsomes differs with respect to the biotransformation pathway (oxidation versus hydrolysis) responsible for their clearance. This study aims to further explore the species differences in the metabolism of these chemicals. Using a parent depletion approach, rat and human cytochromes P450 (P450s) were screened for their ability to eliminate deltamethrin or esfenvalerate during in vitro incubations. Rat P450 isoforms CYP1A1, CYP2C6, CYP2C11, and CYP3A2 and human P450 isoforms CYP2C8, CYP2C19, and CYP3A5 were capable of metabolizing either pyrethroid. Human CYP2C9 metabolized esfenvalerate but not deltamethrin. Rat and human P450s that metabolize esfenvalerate and deltamethrin do so with similar kinetics. In addition to the liver, a potential site of metabolic elimination of pyrethroids is the blood via serum carboxylesterase (CE) hydrolysis. The serum of rats, but not humans, contains significant quantities of CE. Deltamethrin and esfenvalerate were metabolized effectively by rat serum and a purified rat serum CE. In contrast, neither pyrethroid was metabolized by human serum or purified human serum esterases (acetylcholinesterase and butyrylcholinesterase). These studies suggest that the difference in rates of oxidative metabolism of pyrethroids by rat and human hepatic microsomes is dependent on the expression levels of individual P450 isoforms rather than their specific activity. Furthermore, these studies show that the metabolic elimination of deltamethrin and esfenvalerate in blood may be important to their disposition in rats but not in humans.


Assuntos
Sistema Enzimático do Citocromo P-450/metabolismo , Esterases/sangue , Inseticidas/metabolismo , Nitrilas/metabolismo , Piretrinas/metabolismo , Animais , Biotransformação , Humanos , Hidrólise , Inseticidas/farmacocinética , Isoenzimas/metabolismo , Cinética , Masculino , Microssomos Hepáticos/metabolismo , Nitrilas/farmacocinética , Piretrinas/farmacocinética , Ratos , Ratos Sprague-Dawley , Medição de Risco , Especificidade da Espécie , Spodoptera
10.
Drug Metab Dispos ; 34(10): 1764-71, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16855054

RESUMO

Pyrethroids are neurotoxic pesticides whose pharmacokinetic behavior plays a role in their potency. This study examined the elimination of esfenvalerate and deltamethrin from rat and human liver microsomes. A parent depletion approach in the presence and absence of NADPH was used to assess species differences in biotransformation pathways, rates of elimination, and intrinsic hepatic clearance. Esfenvalerate was eliminated primarily via NADPH-dependent oxidative metabolism in both rat and human liver microsomes. The intrinsic hepatic clearance (CL(INT)) of esfenvalerate was estimated to be 3-fold greater in rodents than in humans on a per kilogram body weight basis. Deltamethrin was also eliminated primarily via NADPH-dependent oxidative metabolism in rat liver microsomes; however, in human liver microsomes, deltamethrin was eliminated almost entirely via NADPH-independent hydrolytic metabolism. The CL(INT) for deltamethrin was estimated to be 2-fold more rapid in humans than in rats on a per kilogram body weight basis. Metabolism by purified rat and human carboxylesterases (CEs) were used to further examine the species differences in hydrolysis of deltamethrin and esfenvalerate. Results of CE metabolism revealed that human carboxylesterase 1 (hCE-1) was markedly more active toward deltamethrin than the class 1 rat CEs hydrolase A and B and the class 2 human CE (hCE-2); however, hydrolase A metabolized esfenvalerate 2-fold faster than hCE-1, whereas hydrolase B and hCE-1 hydrolyzed esfenvalerate at equal rates. These studies demonstrate a significant species difference in the in vitro pathways of biotransformation of deltamethrin in rat and human liver microsomes, which is due in part to differences in the intrinsic activities of rat and human carboxylestersases.


Assuntos
Microssomos Hepáticos/metabolismo , Nitrilas/metabolismo , Piretrinas/metabolismo , Animais , Carboxilesterase/metabolismo , Hidrolases de Éster Carboxílico/metabolismo , Humanos , Hidrólise , Fígado/enzimologia , Fígado/metabolismo , Masculino , Desintoxicação Metabólica Fase I , Microssomos Hepáticos/enzimologia , Nitrilas/farmacocinética , Piretrinas/farmacocinética , Ratos , Ratos Long-Evans , Especificidade da Espécie
11.
Comp Biochem Physiol C Toxicol Pharmacol ; 137(2): 179-89, 2004 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-15050929

RESUMO

This study examined the effects of p,p'-dichlorodiphenyltrichloroethane (p,p'-DDT), fasting and flight on thyroid hormones and corticosterone in Gambel's White-crowned Sparrows (Zonotrichia leucophrys gambelli). Female sparrows were dosed daily with either 5 mg p,p'-DDT per kg body mass or corn oil vehicle over 3 days. On the fifth day the sparrows were divided into 3 groups: (1) unstressed - non-stressed control sparrows; (2) fasted - sparrows fasted for intervals ranging from 20 min to 9 h; or (3) flown - sparrows flown in a wind tunnel for intervals between 20 min and 2.5 h while fasting. Half the sparrows from each group received DDT (DDT-dosed sparrows) and the other half corn oil vehicle only (vehicle sparrows). Trunk blood plasma was analyzed for thyroxine, triiodothyronine and corticosterone using radioimmunoassay. In the flown group, corticosterone was elevated (DDT-dosed 35.52 ng/ml, P < or = 0.05), and thyroxine was depressed (DDT-dosed 4.09 ng/ml, P < or = 0.05; vehicle 4.33 ng/ml, P < or = 0.05). Elevated corticosterone likely decreased thyroid hormone production through a negative feedback mechanism originating at the hypothalamus. Mean triiodothyronine concentrations did not differ among any of the test groups. Relative to time fasted and flown, thyroxine decreased in flown birds dosed with DDT (P < 0.001) and triiodothyronine decreased in fasted birds dosed with DDT (P = 0.004). The increased rate of hormone diminution may be a result of the ability of DDT to induce microsomal enzyme production.


Assuntos
Corticosterona/sangue , DDT/farmacologia , Jejum/sangue , Voo Animal/fisiologia , Aves Canoras/sangue , Hormônios Tireóideos/sangue , Animais , Feminino , Estresse Fisiológico/sangue , Tiroxina/sangue , Tri-Iodotironina/sangue
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...