Valores de referência da aldosterona e da razão aldosterona/renina para rastreio e diagnóstico de hiperaldosteronismo primário em pacientes com hipertensão arterial resistente
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Tipo de documento: | Tese |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações da Uninove |
Texto Completo: | http://bibliotecatede.uninove.br/handle/tede/2758 |
Resumo: | Introduction: Primary hyperaldosteronism (PAH) is the main cause of endocrine hypertension in patients with secondary hypertension, and is a prevalent condition in resistant hypertensive patients. For PAH screening, the plasma aldosterone (A) concentration is simultaneously measured with the plasma renin activity (APR) or with the direct renin concentration (R), and the A/APR ratio values or A/R. According to the guidelines, the values that suggest the presence of PAH in the general population of hypertensive individuals are: aldosterone> 15ng/dL and A/APR≥30 ratio or A/R ratio ≥2.5. To confirm PAH, functional tests, adrenal imaging tests and, when available, catheterization of the adrenal veins for blood collection and hormonal measurements are performed. The reference values for suspected and diagnosed PH, based on the criteria presented, may vary in different populations. Few studies have evaluated the ratio A/APR and A/R for screening and confirmation of PAH in resistant hypertensive patients with comorbidities. Objectives: Determine the reference values of A, the ratio A/APR and A/R for suspected and diagnosed PH in patients with Resistant Arterial Hypertension (RAH), based on data from the electronic medical record of hypertensive patients treated at a tertiary service. Still, it is intended to determine if there are differences in the A/APR and A/R ratios in the male and female population. Methods: This is a retrospective analysis of a database of 6,000 patients of both sexes, treated between 2008 and 2018 in a specialized outpatient service. Data from all patients who had simultaneous A and APR or R measurements were included. Clinical (age, sex, systolic and diastolic blood pressure), anthropometric (weight, height, BMI) and laboratory (plasma and urinary sodium, potassium, urea, creatinine, glycemia and glycated hemoglobin) and were calculated at estimated glomerular filtration rates. Duplicate records and unpaired dosages of aldosterone and renin were excluded. Exploratory analyzes were carried out in order to establish the distribution of mean, median and percentile values (2.5 to 97.5%) of A, APR, R, and A/APR and A/R ratios in the general male population and feminine. The clinical and laboratory profile between genders was compared and patients whose ratio values were suspected of PAH were separated. Cutoff points were established using the ROC curve. New data were researched to verify if the PAH confirmatory exams were performed. A multivariate logistic regression model was derived and validated to predict the diagnosis of PAH. Results: The information of 3,268 patients was analyzed, with a mean age of 59.2 years with (SD = 13.3 years), a minimum age of 12 and a maximum age of 96 years. It was observed that 59.2% of the patients (N = 1,934) were female. It was found that the mean age, BMI, SBP, HbA1C and GFR were significantly higher in women compared to men, and an inverse pattern occurred with regard to urinary creatinine, urea and Na + values. The mean values of aldosterone, APR, A/APR and R were significantly higher in men compared to women. The A/R ratio showed no gender differences. A total of 349 patients (10.7% of the total) presented values of A and the A/APR ratio or A/R ratios compatible that indicated suspected PAH. Among these patients, 67 patients underwent confirmatory evaluation, and PAH was confirmed by the presence of adrenal adenoma. Through the analysis of multivariate logistic regression, the ROC curve was obtained for the variables of interest. In our population, it was found that the cutoff point with aldosterone≥13.35 ng/dL and the A/APR values ≥ 26.88 or A/R ≥ 2.45 respectively had an adjusted odds ratio of 15 and 75 times greater than presenting PAH in relation to patients without this condition. Conclusion: Our data demonstrate that new reference points for aldosterone, the ratio A/APR and A/R can be a convenient option for the measurement and screening of the diagnosis of PAH in a population of resistant hypertensive patients. |
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Consolim-Colombo, Fernanda Marcianohttp://lattes.cnpq.br/8102854014364848Consolim-Colombo, Fernanda Marcianohttp://lattes.cnpq.br/8102854014364848Camacho, Cléber Pintohttp://lattes.cnpq.br/1832800364435894Almeida, MadsonBortolotto, Luiz Aparecidohttp://lattes.cnpq.br/5879084252017235Moretti, Miguel Antoniohttp://lattes.cnpq.br/2443815129279382http://lattes.cnpq.br/7884010740017537Silveira, João Vicente2021-11-18T19:07:37Z2020-12-10Silveira, João Vicente. Valores de referência da aldosterona e da razão aldosterona/renina para rastreio e diagnóstico de hiperaldosteronismo primário em pacientes com hipertensão arterial resistente. 2020. 84 f. Tese( Programa de Mestrado em Medicina) - Universidade Nove de Julho, São Paulo.http://bibliotecatede.uninove.br/handle/tede/2758Introduction: Primary hyperaldosteronism (PAH) is the main cause of endocrine hypertension in patients with secondary hypertension, and is a prevalent condition in resistant hypertensive patients. For PAH screening, the plasma aldosterone (A) concentration is simultaneously measured with the plasma renin activity (APR) or with the direct renin concentration (R), and the A/APR ratio values or A/R. According to the guidelines, the values that suggest the presence of PAH in the general population of hypertensive individuals are: aldosterone> 15ng/dL and A/APR≥30 ratio or A/R ratio ≥2.5. To confirm PAH, functional tests, adrenal imaging tests and, when available, catheterization of the adrenal veins for blood collection and hormonal measurements are performed. The reference values for suspected and diagnosed PH, based on the criteria presented, may vary in different populations. Few studies have evaluated the ratio A/APR and A/R for screening and confirmation of PAH in resistant hypertensive patients with comorbidities. Objectives: Determine the reference values of A, the ratio A/APR and A/R for suspected and diagnosed PH in patients with Resistant Arterial Hypertension (RAH), based on data from the electronic medical record of hypertensive patients treated at a tertiary service. Still, it is intended to determine if there are differences in the A/APR and A/R ratios in the male and female population. Methods: This is a retrospective analysis of a database of 6,000 patients of both sexes, treated between 2008 and 2018 in a specialized outpatient service. Data from all patients who had simultaneous A and APR or R measurements were included. Clinical (age, sex, systolic and diastolic blood pressure), anthropometric (weight, height, BMI) and laboratory (plasma and urinary sodium, potassium, urea, creatinine, glycemia and glycated hemoglobin) and were calculated at estimated glomerular filtration rates. Duplicate records and unpaired dosages of aldosterone and renin were excluded. Exploratory analyzes were carried out in order to establish the distribution of mean, median and percentile values (2.5 to 97.5%) of A, APR, R, and A/APR and A/R ratios in the general male population and feminine. The clinical and laboratory profile between genders was compared and patients whose ratio values were suspected of PAH were separated. Cutoff points were established using the ROC curve. New data were researched to verify if the PAH confirmatory exams were performed. A multivariate logistic regression model was derived and validated to predict the diagnosis of PAH. Results: The information of 3,268 patients was analyzed, with a mean age of 59.2 years with (SD = 13.3 years), a minimum age of 12 and a maximum age of 96 years. It was observed that 59.2% of the patients (N = 1,934) were female. It was found that the mean age, BMI, SBP, HbA1C and GFR were significantly higher in women compared to men, and an inverse pattern occurred with regard to urinary creatinine, urea and Na + values. The mean values of aldosterone, APR, A/APR and R were significantly higher in men compared to women. The A/R ratio showed no gender differences. A total of 349 patients (10.7% of the total) presented values of A and the A/APR ratio or A/R ratios compatible that indicated suspected PAH. Among these patients, 67 patients underwent confirmatory evaluation, and PAH was confirmed by the presence of adrenal adenoma. Through the analysis of multivariate logistic regression, the ROC curve was obtained for the variables of interest. In our population, it was found that the cutoff point with aldosterone≥13.35 ng/dL and the A/APR values ≥ 26.88 or A/R ≥ 2.45 respectively had an adjusted odds ratio of 15 and 75 times greater than presenting PAH in relation to patients without this condition. Conclusion: Our data demonstrate that new reference points for aldosterone, the ratio A/APR and A/R can be a convenient option for the measurement and screening of the diagnosis of PAH in a population of resistant hypertensive patients.Introdução: O hiperaldosteronismo primário (HAP) é a principal causa de hipertensão endócrina em pacientes com hipertensão secundária, e é uma condição prevalente em hipertensos resistentes. Para o rastreio de HAP, dosa-se simultaneamente a concentração de aldosterona (A) plasmática com a atividade plasmática da renina (APR) ou com a concentração direta da renina (R), e calcula-se os valores da razão da A/APR ou A/R. De acordo com as diretrizes, os valores que sugerem a presença de HAP na população geral de hipertensos, são: aldosterona>15ng/dL e razão A/APR≥30 ou razão A/R ≥2,5. Para confirmação do HAP, realizam-se testes funcionais, exames de imagem das suprarrenais e, quando disponível, cateterismo das veias suprarrenais para coleta de sangue e dosagens hormonais. Os valores de referência para suspeita e diagnóstico de HP, baseando-se nos critérios apresentados, podem variar em diferentes populações. Poucos estudos avaliaram a razão A/APR e da A/R para rastreio e confirmação de HAP em pacientes hipertensos resistentes, com comorbidades. Objetivos: Determinar os valores de referência da A, da razão A/APR e A/R para suspeita e diagnóstico de HP em pacientes com Hipertensão Arterial Resistente (HAR), usando como base dados do prontuário eletrônico dos pacientes hipertensos atendidos em um serviço terciário. Ainda, pretende-se determinar se existem diferenças nas razões A/APR e da A/R na população masculina e feminina. Métodos: Trata-se da análise retrospectiva de um banco de dados de 6.000 pacientes de ambos os sexos, atendidos no período entre 2008 e 2018 em um serviço ambulatorial especializado. Foram incluídos dados de todos os pacientes que tiveram dosagens simultâneas de A e APR ou R. Foram coletadas variáveis clínicas (idade, sexo, pressão arterial sistólica e diastólica), antropométricas (peso, altura, IMC) e laboratoriais (sódio plasmático e urinário, potássio, ureia, creatinina, glicemia e hemoglobina glicada) e foram calculadas a taxas estimadas de filtração glomerular. Excluíram-se os registros duplicados e dosagens não pareadas da aldosterona e da renina. Foram realizadas análises exploratórias a fim de estabelecer a distribuição de valores médios, mediana e de percentis (2,5 a 97,5%) da A, APR, R, e das razões A/APR e A/R na população geral, masculina e feminina. Comparou-se o perfil clínico-laboratorial entre os sexos e, separou-se os pacientes cujos valores da razão foram suspeitos de HAP. Foram estabelecidos pontos de corte usando a curva ROC. Novos dados foram pesquisados para verificar se houve a realização dos exames confirmatórios de HAP. Um modelo de regressão logística multivariado foi derivado e validado para predizer o diagnóstico de HAP. Resultados: Analisaram-se as informações de 3.268 pacientes, com média de idade de 59,2 anos com (DP= 13,3 anos), idade mínima de 12 e máxima de 96 anos. Observou-se que 59,2% dos pacientes (N=1.934) eram do sexo feminino. Verificou-se que as médias da idade, IMC, PAS, HbA1C e TFG foram significativamente mais elevadas nas mulheres comparadas às dos homens, e um padrão inverso ocorreu com relação aos valores de creatinina, ureia e Na+ urinário. Os valores das médias de aldosterona, APR, A/APR e R foram significativamente maiores nos homens comparados aos das mulheres. A razão da A/R não mostrou diferenças entre os sexos. Um total de 349 pacientes (10,7% do total) apresentou valores de A e da razão A/APR ou razão A/R compatíveis que indicavam suspeita de HAP. Dentre esses pacientes, 67 pacientes foram submetidos a avaliação confirmatória, e se chegou à confirmação de HAP pela presença de adenoma de suprarrenal. Por meio da análise da regressão logística multivariada, obteve-se a curva ROC para as variáveis de interesse. Em nossa população, constatou-se que o ponto de corte com a aldosterona≥13,35 ng/dL e respectivamente os valores da A/APR ≥ 26,88 ou A/R ≥ 2,45 apresentam razão de chance ajustada de 15 e 75 vezes maior de apresentar HAP em relação aos pacientes sem esta condição. Conclusão: Nossos dados demonstram que novos pontos de referência da aldosterona, da razão A/APR e A/R podem ser uma opção conveniente para a mensuração e rastreio do diagnóstico de HAP em uma população de hipertensos resistentes.Submitted by Nadir Basilio (nadirsb@uninove.br) on 2021-11-18T19:07:37Z No. of bitstreams: 1 João Vicente.pdf: 2646326 bytes, checksum: cd01709bcc45be38e2fd84b78cfddd5e (MD5)Made available in DSpace on 2021-11-18T19:07:37Z (GMT). No. of bitstreams: 1 João Vicente.pdf: 2646326 bytes, checksum: cd01709bcc45be38e2fd84b78cfddd5e (MD5) Previous issue date: 2020-12-10application/pdfporUniversidade Nove de JulhoPrograma de Mestrado em MedicinaUNINOVEBrasilSaúdehiperaldosteronismo primárioaldosteronaatividade plasmática de reninaconcentração direta da reninarelação aldosterona e atividade plasmática da reninarelação aldosterona e concentração direta da reninaprimary hyperaldosteronismaldosteroneplasma activity of renindirect concentration of reninaldosterone relationship and plasma renin activityCIENCIAS DA SAUDEValores de referência da aldosterona e da razão aldosterona/renina para rastreio e diagnóstico de hiperaldosteronismo primário em pacientes com hipertensão arterial resistenteReference values for aldosterone and aldosterone/renin ratio for screening and diagnosis of primary hyperaldosteronism in patients with resistant arterial hypertension [thesis]info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesis8765449414823306929600info:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da Uninoveinstname:Universidade Nove de Julho (UNINOVE)instacron:UNINOVEORIGINALJoão Vicente.pdfJoão Vicente.pdfapplication/pdf2646326http://localhost:8080/tede/bitstream/tede/2758/2/Jo%C3%A3o+Vicente.pdfcd01709bcc45be38e2fd84b78cfddd5eMD52LICENSElicense.txtlicense.txttext/plain; charset=utf-82165http://localhost:8080/tede/bitstream/tede/2758/1/license.txtbd3efa91386c1718a7f26a329fdcb468MD51tede/27582022-06-03 17:43:10.98oai:localhost: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Biblioteca Digital de Teses e Dissertaçõeshttp://bibliotecatede.uninove.br/PRIhttp://bibliotecatede.uninove.br/oai/requestbibliotecatede@uninove.br||bibliotecatede@uninove.bropendoar:2022-06-03T20:43:10Biblioteca Digital de Teses e Dissertações da Uninove - Universidade Nove de Julho (UNINOVE)false |
dc.title.por.fl_str_mv |
Valores de referência da aldosterona e da razão aldosterona/renina para rastreio e diagnóstico de hiperaldosteronismo primário em pacientes com hipertensão arterial resistente |
dc.title.alternative.eng.fl_str_mv |
Reference values for aldosterone and aldosterone/renin ratio for screening and diagnosis of primary hyperaldosteronism in patients with resistant arterial hypertension [thesis] |
title |
Valores de referência da aldosterona e da razão aldosterona/renina para rastreio e diagnóstico de hiperaldosteronismo primário em pacientes com hipertensão arterial resistente |
spellingShingle |
Valores de referência da aldosterona e da razão aldosterona/renina para rastreio e diagnóstico de hiperaldosteronismo primário em pacientes com hipertensão arterial resistente Silveira, João Vicente hiperaldosteronismo primário aldosterona atividade plasmática de renina concentração direta da renina relação aldosterona e atividade plasmática da renina relação aldosterona e concentração direta da renina primary hyperaldosteronism aldosterone plasma activity of renin direct concentration of renin aldosterone relationship and plasma renin activity CIENCIAS DA SAUDE |
title_short |
Valores de referência da aldosterona e da razão aldosterona/renina para rastreio e diagnóstico de hiperaldosteronismo primário em pacientes com hipertensão arterial resistente |
title_full |
Valores de referência da aldosterona e da razão aldosterona/renina para rastreio e diagnóstico de hiperaldosteronismo primário em pacientes com hipertensão arterial resistente |
title_fullStr |
Valores de referência da aldosterona e da razão aldosterona/renina para rastreio e diagnóstico de hiperaldosteronismo primário em pacientes com hipertensão arterial resistente |
title_full_unstemmed |
Valores de referência da aldosterona e da razão aldosterona/renina para rastreio e diagnóstico de hiperaldosteronismo primário em pacientes com hipertensão arterial resistente |
title_sort |
Valores de referência da aldosterona e da razão aldosterona/renina para rastreio e diagnóstico de hiperaldosteronismo primário em pacientes com hipertensão arterial resistente |
author |
Silveira, João Vicente |
author_facet |
Silveira, João Vicente |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Consolim-Colombo, Fernanda Marciano |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/8102854014364848 |
dc.contributor.referee1.fl_str_mv |
Consolim-Colombo, Fernanda Marciano |
dc.contributor.referee1Lattes.fl_str_mv |
http://lattes.cnpq.br/8102854014364848 |
dc.contributor.referee2.fl_str_mv |
Camacho, Cléber Pinto |
dc.contributor.referee2Lattes.fl_str_mv |
http://lattes.cnpq.br/1832800364435894 |
dc.contributor.referee3.fl_str_mv |
Almeida, Madson |
dc.contributor.referee4.fl_str_mv |
Bortolotto, Luiz Aparecido |
dc.contributor.referee4Lattes.fl_str_mv |
http://lattes.cnpq.br/5879084252017235 |
dc.contributor.referee5.fl_str_mv |
Moretti, Miguel Antonio |
dc.contributor.referee5Lattes.fl_str_mv |
http://lattes.cnpq.br/2443815129279382 |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/7884010740017537 |
dc.contributor.author.fl_str_mv |
Silveira, João Vicente |
contributor_str_mv |
Consolim-Colombo, Fernanda Marciano Consolim-Colombo, Fernanda Marciano Camacho, Cléber Pinto Almeida, Madson Bortolotto, Luiz Aparecido Moretti, Miguel Antonio |
dc.subject.por.fl_str_mv |
hiperaldosteronismo primário aldosterona atividade plasmática de renina concentração direta da renina relação aldosterona e atividade plasmática da renina relação aldosterona e concentração direta da renina |
topic |
hiperaldosteronismo primário aldosterona atividade plasmática de renina concentração direta da renina relação aldosterona e atividade plasmática da renina relação aldosterona e concentração direta da renina primary hyperaldosteronism aldosterone plasma activity of renin direct concentration of renin aldosterone relationship and plasma renin activity CIENCIAS DA SAUDE |
dc.subject.eng.fl_str_mv |
primary hyperaldosteronism aldosterone plasma activity of renin direct concentration of renin aldosterone relationship and plasma renin activity |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE |
description |
Introduction: Primary hyperaldosteronism (PAH) is the main cause of endocrine hypertension in patients with secondary hypertension, and is a prevalent condition in resistant hypertensive patients. For PAH screening, the plasma aldosterone (A) concentration is simultaneously measured with the plasma renin activity (APR) or with the direct renin concentration (R), and the A/APR ratio values or A/R. According to the guidelines, the values that suggest the presence of PAH in the general population of hypertensive individuals are: aldosterone> 15ng/dL and A/APR≥30 ratio or A/R ratio ≥2.5. To confirm PAH, functional tests, adrenal imaging tests and, when available, catheterization of the adrenal veins for blood collection and hormonal measurements are performed. The reference values for suspected and diagnosed PH, based on the criteria presented, may vary in different populations. Few studies have evaluated the ratio A/APR and A/R for screening and confirmation of PAH in resistant hypertensive patients with comorbidities. Objectives: Determine the reference values of A, the ratio A/APR and A/R for suspected and diagnosed PH in patients with Resistant Arterial Hypertension (RAH), based on data from the electronic medical record of hypertensive patients treated at a tertiary service. Still, it is intended to determine if there are differences in the A/APR and A/R ratios in the male and female population. Methods: This is a retrospective analysis of a database of 6,000 patients of both sexes, treated between 2008 and 2018 in a specialized outpatient service. Data from all patients who had simultaneous A and APR or R measurements were included. Clinical (age, sex, systolic and diastolic blood pressure), anthropometric (weight, height, BMI) and laboratory (plasma and urinary sodium, potassium, urea, creatinine, glycemia and glycated hemoglobin) and were calculated at estimated glomerular filtration rates. Duplicate records and unpaired dosages of aldosterone and renin were excluded. Exploratory analyzes were carried out in order to establish the distribution of mean, median and percentile values (2.5 to 97.5%) of A, APR, R, and A/APR and A/R ratios in the general male population and feminine. The clinical and laboratory profile between genders was compared and patients whose ratio values were suspected of PAH were separated. Cutoff points were established using the ROC curve. New data were researched to verify if the PAH confirmatory exams were performed. A multivariate logistic regression model was derived and validated to predict the diagnosis of PAH. Results: The information of 3,268 patients was analyzed, with a mean age of 59.2 years with (SD = 13.3 years), a minimum age of 12 and a maximum age of 96 years. It was observed that 59.2% of the patients (N = 1,934) were female. It was found that the mean age, BMI, SBP, HbA1C and GFR were significantly higher in women compared to men, and an inverse pattern occurred with regard to urinary creatinine, urea and Na + values. The mean values of aldosterone, APR, A/APR and R were significantly higher in men compared to women. The A/R ratio showed no gender differences. A total of 349 patients (10.7% of the total) presented values of A and the A/APR ratio or A/R ratios compatible that indicated suspected PAH. Among these patients, 67 patients underwent confirmatory evaluation, and PAH was confirmed by the presence of adrenal adenoma. Through the analysis of multivariate logistic regression, the ROC curve was obtained for the variables of interest. In our population, it was found that the cutoff point with aldosterone≥13.35 ng/dL and the A/APR values ≥ 26.88 or A/R ≥ 2.45 respectively had an adjusted odds ratio of 15 and 75 times greater than presenting PAH in relation to patients without this condition. Conclusion: Our data demonstrate that new reference points for aldosterone, the ratio A/APR and A/R can be a convenient option for the measurement and screening of the diagnosis of PAH in a population of resistant hypertensive patients. |
publishDate |
2020 |
dc.date.issued.fl_str_mv |
2020-12-10 |
dc.date.accessioned.fl_str_mv |
2021-11-18T19:07:37Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/doctoralThesis |
format |
doctoralThesis |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
Silveira, João Vicente. Valores de referência da aldosterona e da razão aldosterona/renina para rastreio e diagnóstico de hiperaldosteronismo primário em pacientes com hipertensão arterial resistente. 2020. 84 f. Tese( Programa de Mestrado em Medicina) - Universidade Nove de Julho, São Paulo. |
dc.identifier.uri.fl_str_mv |
http://bibliotecatede.uninove.br/handle/tede/2758 |
identifier_str_mv |
Silveira, João Vicente. Valores de referência da aldosterona e da razão aldosterona/renina para rastreio e diagnóstico de hiperaldosteronismo primário em pacientes com hipertensão arterial resistente. 2020. 84 f. Tese( Programa de Mestrado em Medicina) - Universidade Nove de Julho, São Paulo. |
url |
http://bibliotecatede.uninove.br/handle/tede/2758 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.cnpq.fl_str_mv |
8765449414823306929 |
dc.relation.confidence.fl_str_mv |
600 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
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application/pdf |
dc.publisher.none.fl_str_mv |
Universidade Nove de Julho |
dc.publisher.program.fl_str_mv |
Programa de Mestrado em Medicina |
dc.publisher.initials.fl_str_mv |
UNINOVE |
dc.publisher.country.fl_str_mv |
Brasil |
dc.publisher.department.fl_str_mv |
Saúde |
publisher.none.fl_str_mv |
Universidade Nove de Julho |
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reponame:Biblioteca Digital de Teses e Dissertações da Uninove instname:Universidade Nove de Julho (UNINOVE) instacron:UNINOVE |
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Universidade Nove de Julho (UNINOVE) |
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UNINOVE |
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UNINOVE |
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Biblioteca Digital de Teses e Dissertações da Uninove |
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Biblioteca Digital de Teses e Dissertações da Uninove |
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Biblioteca Digital de Teses e Dissertações da Uninove - Universidade Nove de Julho (UNINOVE) |
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bibliotecatede@uninove.br||bibliotecatede@uninove.br |
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