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1.
An Bras Dermatol ; 94(6): 717-720, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31789249

RESUMO

Confluent and reticulated papillomatosis of Gougerot and Carteaud is a rare dermatosis with onset during puberty, more prevalent in females than in males. The pathogenesis is unknown, but some theories suggest either a keratinization or endocrine disorder. The lesions are verrucous, brownish, hyperkeratotic papules or spots that coalesce in a confluent and/or reticulated pattern. This report presents a case with extensive cutaneous involvement associated with acanthosis nigricans and good response to treatment with methotrexate.


Assuntos
Fármacos Dermatológicos/uso terapêutico , Metotrexato/uso terapêutico , Papiloma/tratamento farmacológico , Papiloma/patologia , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/patologia , Adolescente , Biópsia , Eritema/patologia , Humanos , Masculino , Resultado do Tratamento
2.
An Bras Dermatol ; 94(6): 713-716, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31789267

RESUMO

Hyperzincemia and hypercalprotectinemia is a rare inflammatory disease caused by a mutation in the PSTPIP1 gene, with a dysregulation of calprotectin metabolism. Calprotectin is a zinc-binding protein with antimicrobial properties and pro-inflammatory action. The authors report the case of a 20 year-old girl with cutaneous ulcers comparable with pyoderma gangrenosum, growth failure and chronic anemia, who was given the diagnosis of hyperzincemia and hypercalprotectinemia. Measurement of serum zinc and calprotectin concentrations are indicated in these cases.


Assuntos
Erros Inatos do Metabolismo dos Metais/patologia , Pioderma Gangrenoso/patologia , Ciclosporina/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Feminino , Glucocorticoides/uso terapêutico , Humanos , Complexo Antígeno L1 Leucocitário/sangue , Erros Inatos do Metabolismo dos Metais/tratamento farmacológico , Prednisolona/uso terapêutico , Resultado do Tratamento , Adulto Jovem , Zinco/sangue
5.
Drugs Today (Barc) ; 55(10): 615-625, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31720559

RESUMO

Sarecycline hydrochloride (Seysara) is a novel, narrow-spectrum tetracycline derivative approved by the U.S. Food and Drug Administration (FDA) in October 2018 for the treatment of inflammatory non-nodular moderate to severe acne vulgaris. It was initially developed by Paratek Pharmaceuticals, Inc. (U.S.) and Allergan plc (U.S.), which later was acquired by Almirall S.A. (Barcelona, Spain). Almirall S.A. obtained U.S. FDA approval of oral sarecycline tablets under the trade name Seysara. Sarecycline exhibits antibacterial activity against important skin/soft tissue pathogens with targeted activity against Cutibacterium acnes--an anaerobic Gram-positive bacterium linked with acne lesions--and also exerts anti-inflammatory effects as do other tetracyclines used in the treatment of acne vulgaris. Interestingly, unlike the broad-spectrum tetracyclines, sarecycline is less potent against aerobic Gram-negative bacilli and anaerobic bacteria associated with endogenous intestinal microbial flora. This provides it with a more specific antibacterial spectra with lower chances of adverse off-target antibacterial effects, thus making it a promising choice of treatment over others in its class. It has also demonstrated low propensity to resistance as compared with other tetracyclines and is also active against tetracycline-resistant Staphylococcus aureus as well as erythromycin- and clindamycin-resistant C. acnes strains. Sarecycline has successfully undergone numerous phase I, phase II and three phase III studies establishing it as a well-tolerated once-daily oral drug available as a tablet for the treatment of patients 9 years of age or above.


Assuntos
Acne Vulgar/tratamento farmacológico , Antibacterianos/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Tetraciclinas/uso terapêutico , Aprovação de Drogas , Humanos , Estados Unidos , United States Food and Drug Administration
6.
J Drugs Dermatol ; 18(11)2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31741361

RESUMO

Background: Melasma is an acquired skin disease characterized by symmetric hyperpigmentation on sun-exposed areas, particularly on the face. Recently, there has been tremendous scientific interest in novel, safe, and effective topical agents to manage melasma. Objective: To evaluate topical treatments for melasma and provide evidence-based recommendations for clinical use and further research. Methods: We performed a systematic review of randomized controlled trials (RCTs) on topical agents for the treatment of melasma on March 4th, 2019 using PRISMA guidelines. Clinical recommendations were based on the American College of Physicians guidelines. Results: After screening, we identified 35 original RCTs using azelaic acid, cysteamine, epidermal growth factor, hydroquinone (liposomal-delivered), lignin peroxidase, mulberry extract, niacinamide, Rumex occidentalis, triple combination therapy, tranexamic acid, 4-n-butylresorcinol, glycolic acid, kojic acid, aloe vera, ascorbic acid, dioic acid, ellagic acid and arbutin, flutamide, parsley, or zinc sulfate for melasma. Conclusions: Cysteamine, triple combination therapy, and tranexamic acid received strong clinical recommendations for the treatment of melasma. Cysteamine has excellent efficacy and is reported to have anti-cancer properties, but has not been directly compared with hydroquinone. Triple combination agents and tranexamic acid are effective, but carry theoretical risks for ochronosis and thrombosis, respectively. Natural compounds are associated with low risk for adverse events, but more research is needed to determine the efficacy, optimal formulation, and appropriate concentration of novel treatments. J Drugs Dermatol. 2019;18(11):1156-1171.


Assuntos
Fármacos Dermatológicos/uso terapêutico , Melanose/tratamento farmacológico , Administração Cutânea , Fármacos Dermatológicos/administração & dosagem , Humanos , Guias de Prática Clínica como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto
7.
Medicine (Baltimore) ; 98(43): e17607, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651869

RESUMO

BACKGROUND: This study aims to provide the best possible evidence-based information on the efficacy and safety of sifalimumab for treatment of skin injury (SI) caused by systemic lupus erythematosus (SLE). METHODS: In this study, electronic databases of MEDLINE, EMBASE, Cochrane Library, PsycINFO, CINAHL Plus, Global Health, WHO Global Index Medicus, Virtual Health Library, Social Care Online, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure will be searched comprehensively from inceptions to June 30, 2019 without language restrictions. We will include randomized controlled trials (RCTs) on evaluating the efficacy and safety of sifalimumab for SI caused by SLE. Two investigators will conduct study selection, data extraction, and risk of bias assessment independently. We will use RevMan 5.3 Software to perform statistical analysis. RESULTS: This study will lie in the exhaustive and systematic nature of the literature search and its methods for evaluating quality and analyzing RCTs data. Considering the controversial efficacy of the treatment for sifalimumab, this study is responsible for improving the existing evidence on the efficacy and safety of sifalimumab for SI caused by SLE. CONCLUSION: The results of this study will provide latest evidence for judging whether sifalimumab is an effective intervention for patients with SI caused by SLE or not. STUDY REGISTRATION: CRD42019148225.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Lúpus Eritematoso Sistêmico/complicações , Dermatopatias/tratamento farmacológico , Pele/lesões , Anticorpos Monoclonais Humanizados , Humanos , Projetos de Pesquisa , Dermatopatias/etiologia , Revisão Sistemática como Assunto , Resultado do Tratamento
8.
J Drugs Dermatol ; 18(10): 987-990, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31584776

RESUMO

Introduction: Introduction: Although future atopic dermatitis (AD) clinical research is intended to improve standard-of-care treatment, how patients are currently treated is not well characterized. The purpose of this study was to determine the most frequent medications prescribed in all ages of AD. Methods: The National Ambulatory Medical Care Survey (NAMCS) is a nationally representative survey of United States office-based ambulatory visits and records demographics, diagnoses, and treatments. This is a cross-sectional study using the NAMCS of all AD outpatient office visits from 2006 to 2015. Patient visits with an ICD-9-CM code for AD (691.8) were collected and analyzed. Frequency tables were created for age, race, providers managing AD, and treatment. Results: Patient demographics of AD visits included 51% male (95% Confidence Interval [CI]: 44-58%), 71% white (65-77%), 19% African American (14-25%), and 10% Asian (6-14%). About 31% (24-37%) of visits were to pediatricians and 27% (22-33%) to dermatologists whereas per physician, dermatologists managed more AD visits than pediatricians. Topical corticosteroids (59%; 52-66%) were the most common class of medications prescribed followed by antibiotics (11%; 6-16%) and second generation antihistamines (6%; 3-10%). The most common topical corticosteroid prescribed in AD was triamcinolone (25% of office visits; 18-31%). Hydrocortisone was the most common topical corticosteroid prescribed to children <1 year of age and children aged 8 to 18, whereas triamcinolone was more common in children 2 to 7 years and adults >18 years. Discussion: Topical corticosteroids were the most frequent prescriptions provided at office-based ambulatory visits whereas antibiotics and second-generation antihistamines were the second and third most common prescribed medications, respectively. Although pediatricians manage more AD visits than dermatologists in total visits, dermatologists manage more AD visits than pediatricians per physician. Characterizing how AD patients are currently treated may build a reference for future clinical research investigating novel standard-of-care treatment in AD. J Drugs Dermatol. 2019;18(10):987-990.


Assuntos
Dermatite Atópica/tratamento farmacológico , Fármacos Dermatológicos/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Padrão de Cuidado/estatística & dados numéricos , Administração Cutânea , Adolescente , Adulto , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Estudos Transversais , Dermatologistas/estatística & dados numéricos , Feminino , Glucocorticoides/uso terapêutico , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Lactente , Recém-Nascido , Masculino , Visita a Consultório Médico/estatística & dados numéricos , Estados Unidos , Adulto Jovem
9.
Hautarzt ; 70(10): 790-796, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31515578

RESUMO

The treatment of hand eczema represents a great challenge in the daily clinical practice for dermatologists. There are various forms of local, physical and systemic treatment, such as alitretinoin which is the only registered systemic treatment option for severe chronic hand eczema. In 2017 dupilumab was approved for the treatment of moderate to severe atopic dermatitis and can theoretically also be applied for atopic hand eczema. The first and most important step in treatment is to identify the underlying etiology of the hand eczema with the appropriate diagnostic measures, ranging from skin biopsy to allergy testing including occupational products. An important component of treatment is the basic treatment in the form of consistent and stage-adapted skin care. Treatment of hand eczema should follow a step by step procedure whereby the basic treatment should be maintained and, depending on the etiology and clinical type, should be supplemented by topical, systemic and physical treatment forms, also often used in parallel. Mild to moderate forms of hand eczema are usually treated with the basic treatment, emollients and topical glucocorticoids according to various guidelines. In moderate to severe forms of hand eczema UV phototherapy and systemic treatment should be implemented. This article summarizes the most important treatment modalities based on case reports and series, clinical studies, guidelines and expert recommendations.


Assuntos
Fármacos Dermatológicos/uso terapêutico , Eczema/terapia , Emolientes/uso terapêutico , Dermatoses da Mão/tratamento farmacológico , Terapia Ultravioleta , Alitretinoína/uso terapêutico , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/prevenção & controle , Dermatite Atópica/terapia , Gerenciamento Clínico , Eczema/diagnóstico , Dermatoses da Mão/diagnóstico , Humanos , Resultado do Tratamento
10.
J Drugs Dermatol ; 18(9): 904-908, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31524346

RESUMO

Dermatologists are among the most inventive physicians, trained in the multiple disciplines of medical dermatology, surgical dermatology, and dermatopathology. Many of the advances in dermatology practice have been derived from inventive colleagues who identify opportunities for improvement in practice, develop viable prototypes to address these practice opportunities, and persevere through the hard work of developing new technologies to advance the practice of dermatology. In this article, we will review the basic elements of invention, patents, and the range of outcomes associated with the pursuit of invention. Examples of innovative dermatologic technologies and approaches will be reviewed. Opportunities abound for dermatologists to contribute to the advancement of medical care through invention in our specialty. J Drugs Dermatol. 2019;18(9):904-908.


Assuntos
Tecnologia Biomédica/métodos , Dermatologia/métodos , Invenções/legislação & jurisprudência , Dermatopatias/terapia , Tecnologia Biomédica/legislação & jurisprudência , Fármacos Dermatológicos/uso terapêutico , Dermatologistas , Dermatologia/instrumentação , Dermatologia/legislação & jurisprudência , Desenho de Equipamento , Humanos , Patentes como Assunto , Dermatopatias/diagnóstico
11.
Tidsskr Nor Laegeforen ; 139(12)2019 09 10.
Artigo em Norueguês | MEDLINE | ID: mdl-31502795

RESUMO

Acne should not be perceived as a self-limiting affliction of adolescence. Due to the growing problem of antimicrobial-resistant bacteria, restrictive use of peroral and topical antibiotics is recommended. There are a number of effective agents for topical treatment of mild to moderate acne. In cases of severe, therapy-resistant acne, treatment with peroral isotretinoin is recommended.


Assuntos
Acne Vulgar/tratamento farmacológico , Antibacterianos/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Acne Vulgar/diagnóstico , Acne Vulgar/etiologia , Acne Vulgar/psicologia , Administração Oral , Administração Tópica , Adolescente , Algoritmos , Antibacterianos/administração & dosagem , Peróxido de Benzoíla/administração & dosagem , Peróxido de Benzoíla/uso terapêutico , Cicatriz/tratamento farmacológico , Fármacos Dermatológicos/administração & dosagem , Humanos , Isotretinoína/administração & dosagem , Isotretinoína/uso terapêutico , Qualidade de Vida
12.
Actas dermo-sifiliogr. (Ed. impr.) ; 110(7): 585-589, sept. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185529

RESUMO

Introducción: Ixekizumab es un fármaco efectivo y seguro en el tratamiento de pacientes con psoriasis dentro de ensayos clínicos. Nuestro objetivo es valorar la eficacia y seguridad de ixekizumab en la práctica clínica habitual. Material: Estudio retrospectivo incluyendo todos los pacientes que han recibido ixekizumab en 2 servicios de dermatología de la ciudad de Valencia. Resultados: Se incluyeron un total de 75 pacientes, siendo el 53,3% varones y el 46,7% mujeres con una edad media de 48,61 años. El 77,3% (58 pacientes) presentaba una psoriasis en placas, mientras que el 22,7% (17 pacientes) presentaba psoriasis de predominio en un área especial. La comorbilidad más frecuente fue obesidad en el 48% de ellos y el 40% eran naive a biológicos. El PASI inicial medio fue de 9,99, mientras que el PASI medio a la semana 16 era de 1,5. Las respuestas de PASI75 y PASI90 fueron independientes de las comorbilidades analizadas, del sexo, de la edad y del PASI basal. Los pacientes naive a biológicos respondieron mejor que los pacientes que habían recibido tratamiento biológico previo, tanto en la semana 16 como en la semana 52 de forma estadísticamente significativa. Esta observación también se mantuveroni en los pacientes con psoriasis en un área especial. El 25,7% de los pacientes refería algún efecto adverso, siendo lo más frecuente reacción en el sitio de inyección. No se observaron reacciones adversas graves. Conclusiones: El estudio plasma nuestra experiencia en la práctica clínica real de ixekizumab, siendo un fármaco efectivo y seguro para el tratamiento de la psoriasis


Background: Ixekizumab has proven efficacy and safety for the treatment of psoriasis in clinical trials. The aim of this study was to evaluate its effectiveness and safety in routine clinical practice. Methods: Retrospective study of all patients treated with ixekizumab in 2 dermatology departments in the city of Valencia, Spain. Results: Seventy-five patients (53.3% men and 46.7% women) with a mean age of 48.61 years were studied; 77.3% (n = 58) had plaque psoriasis and 22.7% (n = 17) had psoriasis predominantly affecting a specific area. The most common comorbidity was obesity (present in 48% of patients) and 40% of the overall group had not been previously treated with a biologic drug. Mean psoriasis area and severity index (PASI) fell from 9.99 at baseline to 1.5 at week 16. PASI-75 and PASI-90 (improvements of at least 75% and 90% in PASI) were independent of sex, age, baseline PASI, and the comorbidities analyzed. Responses at week 16 and 52 were significantly better in biologic-naïve patients for the overall group and the subgroup of patients with localized psoriasis. Adverse effects were reported for 25.7% of patients and the most common effect was injection-site reaction. There were no serious adverse effects. Conclusions: Our findings show that ixekizumab is both effective and safe in the treatment of psoriasis in routine clinical practice


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Anticorpos Monoclonais Humanizados/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Psoríase/tratamento farmacológico , Prática Profissional , Avaliação de Resultados (Cuidados de Saúde) , Segurança do Paciente , Estudos Retrospectivos , Análise Estatística
13.
J Drugs Dermatol ; 18(8): 731-740, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31424705

RESUMO

IMPORTANCE: There are increasing options for systemic combination therapy for psoriasis but a lack of literature around the characteristics of patients who are started on these regimens. OBJECTIVE: We aimed to determine how combination systemic therapy patients differ from monotherapy patients in their social, medical, or treatment history. DESIGN: This was a cross-sectional study of patients enrolled in the Corrona Psoriasis Registry. Descriptive characteristics were compared in biologic monotherapy and combination therapy groups. SETTING: The Corrona PsO registry is a prospective multicenter observational disease-based registry with patients recruited from 154 private and academic practice sites in the US and Canada with 373 participating dermatologists. PARTICIPANTS: Patients 18 years of age or older who enrolled in the Corrona Psoriasis Registry between April 2015 and March 2017 and initiated an eligible biologic therapy at the time of enrollment were included. EXPOSURES: Eligible biologic therapies included adalimumab, etanercept, infliximab, ixekizumab, secukinumab, and ustekinumab. Non-biologic and small molecule adjunctive therapies included acitretin, apremilast, CsA, and MTX. RESULTS: Patients on combination therapy were more likely to identify as black, to have Medicaid, and to report disabled work status. While combination therapy patients were more likely to have concomitant PsA, no major differences were seen in disease morphology, duration, IGA, PASI, or BSA affected at treatment initiation. CONCLUSIONS: Various demographic and socioeconomic factors are associated with use of combination systemic therapy compared to use of systemic monotherapy for psoriasis. An association with commonly used disease severity indices was not observed. RELEVANCE: An understanding of which patients are more likely to be prescribed combination systemic therapy will provide important context for long-term efficacy and safety data as they become available.


Assuntos
Produtos Biológicos/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Psoríase/tratamento farmacológico , Adolescente , Adulto , Idoso , Canadá , Estudos Transversais , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos , Psoríase/diagnóstico , Sistema de Registros/estatística & dados numéricos , Índice de Gravidade de Doença , Resultado do Tratamento , Estados Unidos , Adulto Jovem
15.
J Pak Med Assoc ; 69(Suppl 2)(6): S57-S63, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31369535

RESUMO

Objective: Eczema, a chronic dermatologic disease, has been recognized as an economic burden in publications all over the word but only minimally as such in Vietnam. The aim of this prospective study was to quantify the financial hardships and impairments suffered by eczema patients. Methods: This cross-sectional prevalence-based study involved 136 patients, whose conditions were classified into three severity levels on the basis of the medications that they were prescribed. Prescription therapy was administered for a month, after which there was patient-oriented assessment of effectiveness. The work productivity and activity impairment (WPAI) questionnaire was used to evaluate productivity loss, which was expressed in percentage form. Bootstrapping was conducted to determine continuous variables and demographybased differences in cost values among the patient groups. Results: For the month-long treatment, each eczema patient needed an average of US$68.1 (range: US$56.2- US$81.5) with the highest proportion being spent on cosmetic treatments. There is noticeable difference between groups among which patients' symptoms demonstrated in distinct levels. The estimates indicated that eczema resulted in 27.8% and 23.1% impairments in work and daily activities, respectively. Conclusions: The aggravation of disease symptoms can increase the direct costs borne by eczema patients. A decrease in productivity, which is one of the most serious consequences of the condition, should be paid adequate attention to minimize burdens to society.


Assuntos
Dermatite Atópica/economia , Eficiência , Desempenho Profissional/economia , Absenteísmo , Corticosteroides/economia , Corticosteroides/uso terapêutico , Adulto , Idoso , Inibidores de Calcineurina/economia , Inibidores de Calcineurina/uso terapêutico , Cosméticos/economia , Cosméticos/uso terapêutico , Estudos Transversais , Dermatite Atópica/terapia , Fármacos Dermatológicos/economia , Fármacos Dermatológicos/uso terapêutico , Suplementos Nutricionais/economia , Custos de Medicamentos , Emolientes/economia , Emolientes/uso terapêutico , Feminino , Seguimentos , Custos de Cuidados de Saúde , Antagonistas dos Receptores Histamínicos/economia , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Higiene da Pele , Vietnã
16.
An Bras Dermatol ; 94(3): 313-319, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31365660

RESUMO

BACKGROUND: Actinic keratosis (AK) represents a risk of progression to squamous cell carcinoma. Ingenol mebutate gel is a novel therapeutic option for field-directed treatment. OBJECTIVES: To evaluate the safety, tolerability and patients' perspectives, related to the therapeutic success of managing AKs on the face and scalp with ingenol mebutate gel in Brazilian individuals. METHODS: This was an observational, retrospective and descriptive study of 68 areas of actinic keratosis on the face and scalp treated with Ingenol mebutate gel involving a total of 37 patients. The drug was applied for three consecutive days on an area of of 25 cm2 and documentation was performed on baseline and days 4, 8, 15, 60 and 180. On day 4, the composite local skin reaction score was calculated. At the end, a questionnaire was applied to evaluate patients' perspectives about the treatment. RESULTS: Adherence was 100%, no serious adverse events were recorded and the mean composite local skin reaction score (standard deviation) was 8.61±4.22. The treatment was considered optimum by 75.68% of the patients. STUDY LIMITATIONS: Calculation of composite local skin reaction score performed only on the fourth day. CONCLUSIONS: Treatment with ingenol mebutate gel was considered safe and tolerable in Brazilian subjects. Patients had a maximum adherence rate and a great improvement in self-esteem. The results of this research reproduce the findings of the literature.


Assuntos
Fármacos Dermatológicos/uso terapêutico , Diterpenos/uso terapêutico , Géis/uso terapêutico , Ceratose Actínica/tratamento farmacológico , Administração Cutânea , Idoso , Idoso de 80 Anos ou mais , Brasil , Dermatoses Faciais/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Dermatoses do Couro Cabeludo/tratamento farmacológico , Inquéritos e Questionários , Resultado do Tratamento
18.
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