Deficiência de vitamina B12 em receptores de transplante renal: frequência e associação com resistência à insulina, biomarcadores inflamatórios e função microvascular
Autor(a) principal: | |
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Data de Publicação: | 2019 |
Outros Autores: | |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações da UERJ |
Texto Completo: | http://www.bdtd.uerj.br/handle/1/21044 |
Resumo: | Vitamin B12 (B12) deficiency is associated with the development of hyperhomocysteinemia (Hhcys), a risk factor for cardiovascular disease (CVD). There is evidence that B12 may help prevent atherosclerosis due to antioxidant and anti-inflammatory effects. CVD is an important cause of death in kidney transplant recipients (KTR). Longitudinal investigations indicate a relationship between elevated homocysteine levels (hcys) and risk of CVD in KTR. However, the frequency of B12 deficiency and its association with cardiovascular risk markers in these patients is not yet known. The aim of the present study was to evaluate serum levels of B12, determining the frequency of deficiency, and its association with serum levels of hcys, insulin resistance, inflammatory markers, cutaneous microvascular reactivity and retinal vascular diameters in KTR. Observational, cross-sectional and longitudinal study conducted with adult KTR (18-65 years) at least 6 months after kidney transplantation (KTx). Were exluded patients with AIDS, cancer and autoimmune diseases, amputees, under dialysis therapy and using B12 supplements. Laboratory tests performed at baseline: glucose, insulin, B12, hcys, adiponectin, tumor necrosis factor-α, interleukin-8 and C-reactive protein (CRP). After 2 years the KTRs were submitted to the evaluation of laboratory parameters: glucose, insulin, B12, hcys, leptin and CRP; cutaneous microvascular reactivity by Laser Speckle Contrast Imaging; and the diameter of the retinal vessels by nonmidriatic retinography. Glomerular filtration rate was estimated (eGFR; ml/min) by the CKD-EPI equation. Serum B12 concentration at baseline was used to assess the association with all other variables, and deficiency was defined as < 200pg / mL. At baseline, 218 RTR (121 men), 49 (41–55) years, TxR time 115 (26–171) months and eGFR 52 ± 1.4 ml/min were evaluated. The frequency of B12 deficiency was 14% (n=31). At baseline serum B12: (1) was negatively associated with hcys, even after adjusting for age, sex and time from KTx in patients with eGFR ≥60 (r=-0.54; p=0.01), but after additional adjustment for eGFR the association was no longer significant; (2) was significantly lower in the Hhcys group (428 vs. 246pg / mL, p <0.05); (3) was not associated with insulin resistance and inflammatory markers. After 2 years, 171 patients were reevaluated. The analysis of the association betwenn serum levels of B12 obtained at baseline with the variables obtained after 2 years revealed: (1) negative association with insulin (r=-0.40; p=0.01) and HOMA-IR (r=-0.38; p=0.02) in patients with eGFR < 60 after adjustments for age, sex, time of RTx and eGFR, but after additional adjustment for body mass index the association was no longer significant; (2) negative association, after adjustments for confounders, with CRP in KTR with eGFR ≥ 60 (r=-0.43; p=0.04) and with leptin in the total group (r=-0.26; p=0.04) and in those with eGFR < 60 (r=-0.36; p=0.03); (4) absence of association with serum hcys, cutaneous microvascular reactivity and retinal vascular diameters. The present study suggests that in KTR the frequency of B12 deficiency is high and serum levels of B12 are inversely associated with inflammatory markers in longitudinal analysis |
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Klein, Márcia Regina Simas Torreshttp://lattes.cnpq.br/8755810383117085Silva, Maria Ines Barretohttp://lattes.cnpq.br/8042342466024186Bregman, Rachelhttp://lattes.cnpq.br/7952357764139600Borges, Natália Alvarengahttp://lattes.cnpq.br/1752550882237245Ferreira, Thaís da Silvahttp://lattes.cnpq.br/5469539546316695http://lattes.cnpq.br/7428280998444616Costa, Mariana Silva damcostanutri@yahoo.com.br2024-02-07T18:27:05Z2019-11-21COSTA, Mariana Silva da. Deficiência de vitamina B12 em receptores de transplante renal: frequência e associação com resistência à insulina, biomarcadores inflamatórios e função microvascular. 2019. 117 f. Dissertação (Mestrado em Ciências Médicas) - Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2019.http://www.bdtd.uerj.br/handle/1/21044Vitamin B12 (B12) deficiency is associated with the development of hyperhomocysteinemia (Hhcys), a risk factor for cardiovascular disease (CVD). There is evidence that B12 may help prevent atherosclerosis due to antioxidant and anti-inflammatory effects. CVD is an important cause of death in kidney transplant recipients (KTR). Longitudinal investigations indicate a relationship between elevated homocysteine levels (hcys) and risk of CVD in KTR. However, the frequency of B12 deficiency and its association with cardiovascular risk markers in these patients is not yet known. The aim of the present study was to evaluate serum levels of B12, determining the frequency of deficiency, and its association with serum levels of hcys, insulin resistance, inflammatory markers, cutaneous microvascular reactivity and retinal vascular diameters in KTR. Observational, cross-sectional and longitudinal study conducted with adult KTR (18-65 years) at least 6 months after kidney transplantation (KTx). Were exluded patients with AIDS, cancer and autoimmune diseases, amputees, under dialysis therapy and using B12 supplements. Laboratory tests performed at baseline: glucose, insulin, B12, hcys, adiponectin, tumor necrosis factor-α, interleukin-8 and C-reactive protein (CRP). After 2 years the KTRs were submitted to the evaluation of laboratory parameters: glucose, insulin, B12, hcys, leptin and CRP; cutaneous microvascular reactivity by Laser Speckle Contrast Imaging; and the diameter of the retinal vessels by nonmidriatic retinography. Glomerular filtration rate was estimated (eGFR; ml/min) by the CKD-EPI equation. Serum B12 concentration at baseline was used to assess the association with all other variables, and deficiency was defined as < 200pg / mL. At baseline, 218 RTR (121 men), 49 (41–55) years, TxR time 115 (26–171) months and eGFR 52 ± 1.4 ml/min were evaluated. The frequency of B12 deficiency was 14% (n=31). At baseline serum B12: (1) was negatively associated with hcys, even after adjusting for age, sex and time from KTx in patients with eGFR ≥60 (r=-0.54; p=0.01), but after additional adjustment for eGFR the association was no longer significant; (2) was significantly lower in the Hhcys group (428 vs. 246pg / mL, p <0.05); (3) was not associated with insulin resistance and inflammatory markers. After 2 years, 171 patients were reevaluated. The analysis of the association betwenn serum levels of B12 obtained at baseline with the variables obtained after 2 years revealed: (1) negative association with insulin (r=-0.40; p=0.01) and HOMA-IR (r=-0.38; p=0.02) in patients with eGFR < 60 after adjustments for age, sex, time of RTx and eGFR, but after additional adjustment for body mass index the association was no longer significant; (2) negative association, after adjustments for confounders, with CRP in KTR with eGFR ≥ 60 (r=-0.43; p=0.04) and with leptin in the total group (r=-0.26; p=0.04) and in those with eGFR < 60 (r=-0.36; p=0.03); (4) absence of association with serum hcys, cutaneous microvascular reactivity and retinal vascular diameters. The present study suggests that in KTR the frequency of B12 deficiency is high and serum levels of B12 are inversely associated with inflammatory markers in longitudinal analysisA deficiência de vitamina B12 (B12) está associada com o desenvolvimento da hiperhomocisteinemia (Hhcis), um fator de risco para as doenças cardiovasculares (DCV). Existem evidências de que a B12 pode auxiliar na prevenção da aterosclerose por apresentar efeito antioxidante e anti-inflamatório. As DCV representam importante causa de morte em receptores de transplante renal (RTR). Investigações longitudinais indicam relação entre níveis elevados de homocisteína (hcis) e risco de DCV em RTR. No entanto, a frequência de deficiência de B12 e sua associação com marcadores de risco cardiovascular nestes pacientes ainda não é conhecida. O objetivo do presente estudo foi avaliar a concentração sérica de B12, determinando a frequência de deficiência e sua associação com níveis séricos de hcis, resistência à insulina, marcadores inflamatórios, reatividade microvascular cutânea e diâmetros vasculares retinianos em RTR. Estudo observacional, transversal e longitudinal realizado com RTR adultos (18-65 anos) submetidos ao transplante renal (TxR) há pelo menos 6 meses. Foram excluídos pacientes com SIDA, câncer e doenças autoimunes, amputados, em terapia dialítica e em uso de suplementos de B12. No período basal foi realizada avaliação laboratorial: glicose, insulina, B12, hcis, adiponectina, fator de necrose tumoral-α, interleucina-8 e proteína C reativa (PCR). Após 2 anos os RTR foram submetidos a avaliação laboratorial: glicose, insulina, B12, hcis, leptina e PCR; da reatividade microvascular cutânea por Laser Speckle Contrast Imaging; e do diâmetro dos vasos retinianos por retinografia não midriática. A taxa de filtração glomerular foi estimada (TFGe; ml/min) pela equação CKD- EPI. A concentração sérica de B12 no período basal foi utilizada para avaliar a associação com todas as demais variáveis, sendo definida deficiência quando < 200pg/mL. No período basal foram avaliados 218 RTR (121 homens), 49 (41–55) anos, tempo TxR 115 (26–171) meses e TFGe 52±1,4 ml/min. A frequência de deficiência de B12 foi de 14% (n=31). No período basal a B12 sérica: (1) se associou negativamente com a hcis, mesmo após ajuste para idade, sexo e tempo TxR nos pacientes com TFGe ≥60 (r=-0,54; p=0,01), porém após ajuste adicional para TFGe a associação deixou de ser significativa; (2) foi significativamente menor no grupo com Hhcis (428 vs. 246pg/mL, p <0,05); (3) não se associou com resistência à insulina e marcardores inflamatórios. Após 2 anos foram reavaliados 171 pacientes. As análises de associação B12 sérica do período basal com as variáveis obtidas após 2 anos revelaram: (1) associação negativa com insulina (r=-0,40; p=0,01) e HOMA-IR (r=-0,38; p=0,02) nos pacientes com TFGe < 60 após ajustes para idade, sexo, tempo de TxR e TFGe, porém após ajuste adicional para índice de massa corporal a associação deixou de ser significativa; (2) associação negativa, após ajustes para confundidores, com PCR nos RTR com TFGe ≥ 60 (r=-0,43; p=0,04); e com leptina no grupo total (r=-0,26; p=0,04) e naqueles com TFGe < 60 (r=-0,36; p=0,03); (4) ausência de associação com a hcis sérica, reatividade microvascular cutânea e diâmetros vasculares retinianos. O presente estudo sugere que em RTR a frequência de deficiência de B12 é elevada e a B12 sérica está inversamente associada com marcadores inflamatórios na análise longitudinalSubmitted by Felipe CB/A (felipebibliotecario@gmail.com) on 2024-02-07T18:27:05Z No. of bitstreams: 1 Dissertação - Mariana Silva da Costa - 2019 - Completa.pdf: 2465822 bytes, checksum: 421023a4ac883b3c0484b38ad8069fc2 (MD5)Made available in DSpace on 2024-02-07T18:27:05Z (GMT). No. of bitstreams: 1 Dissertação - Mariana Silva da Costa - 2019 - Completa.pdf: 2465822 bytes, checksum: 421023a4ac883b3c0484b38ad8069fc2 (MD5) Previous issue date: 2019-11-21Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro - FAPERJapplication/pdfporUniversidade do Estado do Rio de JaneiroPrograma de Pós-Graduação em Ciências MédicasUERJBrasilCentro Biomédico::Faculdade de Ciências MédicasKidney transplantVitamin B12Insulin resistanceInflammatory markersCutaneous microvascular reactivityRetinal vascular diametersRins – Transplante – Aspectos nutricionaisDeficiência de vitamina B12Resistência à insulinaMarcadores bioquímicosTransplante renalMarcadores inflamatóriosReatividade microvascular cutâneaDiâmetros vasculares retinianosCIENCIAS DA SAUDEDeficiência de vitamina B12 em receptores de transplante renal: frequência e associação com resistência à insulina, biomarcadores inflamatórios e função microvascularVitamin B12 deficiency in kidney transplant recipients: frequency and association with insulin resistance, inflammatory biomarkers and microvascular functioninfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da UERJinstname:Universidade do Estado do Rio de Janeiro (UERJ)instacron:UERJORIGINALDissertação - Mariana Silva da Costa - 2019 - Completa.pdfDissertação - Mariana Silva da Costa - 2019 - Completa.pdfapplication/pdf2465822http://www.bdtd.uerj.br/bitstream/1/21044/2/Disserta%C3%A7%C3%A3o+-+Mariana+Silva+da+Costa+-+2019+-+Completa.pdf421023a4ac883b3c0484b38ad8069fc2MD52LICENSElicense.txtlicense.txttext/plain; charset=utf-82011http://www.bdtd.uerj.br/bitstream/1/21044/1/license.txtba23dde015e31ff1802d858071d990cdMD511/210442024-02-26 15:59:50.43oai:www.bdtd.uerj.br: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Biblioteca Digital de Teses e Dissertaçõeshttp://www.bdtd.uerj.br/PUBhttps://www.bdtd.uerj.br:8443/oai/requestbdtd.suporte@uerj.bropendoar:29032024-02-26T18:59:50Biblioteca Digital de Teses e Dissertações da UERJ - Universidade do Estado do Rio de Janeiro (UERJ)false |
dc.title.por.fl_str_mv |
Deficiência de vitamina B12 em receptores de transplante renal: frequência e associação com resistência à insulina, biomarcadores inflamatórios e função microvascular |
dc.title.alternative.eng.fl_str_mv |
Vitamin B12 deficiency in kidney transplant recipients: frequency and association with insulin resistance, inflammatory biomarkers and microvascular function |
title |
Deficiência de vitamina B12 em receptores de transplante renal: frequência e associação com resistência à insulina, biomarcadores inflamatórios e função microvascular |
spellingShingle |
Deficiência de vitamina B12 em receptores de transplante renal: frequência e associação com resistência à insulina, biomarcadores inflamatórios e função microvascular Costa, Mariana Silva da Kidney transplant Vitamin B12 Insulin resistance Inflammatory markers Cutaneous microvascular reactivity Retinal vascular diameters Rins – Transplante – Aspectos nutricionais Deficiência de vitamina B12 Resistência à insulina Marcadores bioquímicos Transplante renal Marcadores inflamatórios Reatividade microvascular cutânea Diâmetros vasculares retinianos CIENCIAS DA SAUDE |
title_short |
Deficiência de vitamina B12 em receptores de transplante renal: frequência e associação com resistência à insulina, biomarcadores inflamatórios e função microvascular |
title_full |
Deficiência de vitamina B12 em receptores de transplante renal: frequência e associação com resistência à insulina, biomarcadores inflamatórios e função microvascular |
title_fullStr |
Deficiência de vitamina B12 em receptores de transplante renal: frequência e associação com resistência à insulina, biomarcadores inflamatórios e função microvascular |
title_full_unstemmed |
Deficiência de vitamina B12 em receptores de transplante renal: frequência e associação com resistência à insulina, biomarcadores inflamatórios e função microvascular |
title_sort |
Deficiência de vitamina B12 em receptores de transplante renal: frequência e associação com resistência à insulina, biomarcadores inflamatórios e função microvascular |
author |
Costa, Mariana Silva da |
author_facet |
Costa, Mariana Silva da mcostanutri@yahoo.com.br |
author_role |
author |
author2 |
mcostanutri@yahoo.com.br |
author2_role |
author |
dc.contributor.advisor1.fl_str_mv |
Klein, Márcia Regina Simas Torres |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/8755810383117085 |
dc.contributor.advisor-co1.fl_str_mv |
Silva, Maria Ines Barreto |
dc.contributor.advisor-co1Lattes.fl_str_mv |
http://lattes.cnpq.br/8042342466024186 |
dc.contributor.referee1.fl_str_mv |
Bregman, Rachel |
dc.contributor.referee1Lattes.fl_str_mv |
http://lattes.cnpq.br/7952357764139600 |
dc.contributor.referee2.fl_str_mv |
Borges, Natália Alvarenga |
dc.contributor.referee2Lattes.fl_str_mv |
http://lattes.cnpq.br/1752550882237245 |
dc.contributor.referee3.fl_str_mv |
Ferreira, Thaís da Silva |
dc.contributor.referee3Lattes.fl_str_mv |
http://lattes.cnpq.br/5469539546316695 |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/7428280998444616 |
dc.contributor.author.fl_str_mv |
Costa, Mariana Silva da mcostanutri@yahoo.com.br |
contributor_str_mv |
Klein, Márcia Regina Simas Torres Silva, Maria Ines Barreto Bregman, Rachel Borges, Natália Alvarenga Ferreira, Thaís da Silva |
dc.subject.eng.fl_str_mv |
Kidney transplant Vitamin B12 Insulin resistance Inflammatory markers Cutaneous microvascular reactivity Retinal vascular diameters |
topic |
Kidney transplant Vitamin B12 Insulin resistance Inflammatory markers Cutaneous microvascular reactivity Retinal vascular diameters Rins – Transplante – Aspectos nutricionais Deficiência de vitamina B12 Resistência à insulina Marcadores bioquímicos Transplante renal Marcadores inflamatórios Reatividade microvascular cutânea Diâmetros vasculares retinianos CIENCIAS DA SAUDE |
dc.subject.por.fl_str_mv |
Rins – Transplante – Aspectos nutricionais Deficiência de vitamina B12 Resistência à insulina Marcadores bioquímicos Transplante renal Marcadores inflamatórios Reatividade microvascular cutânea Diâmetros vasculares retinianos |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE |
description |
Vitamin B12 (B12) deficiency is associated with the development of hyperhomocysteinemia (Hhcys), a risk factor for cardiovascular disease (CVD). There is evidence that B12 may help prevent atherosclerosis due to antioxidant and anti-inflammatory effects. CVD is an important cause of death in kidney transplant recipients (KTR). Longitudinal investigations indicate a relationship between elevated homocysteine levels (hcys) and risk of CVD in KTR. However, the frequency of B12 deficiency and its association with cardiovascular risk markers in these patients is not yet known. The aim of the present study was to evaluate serum levels of B12, determining the frequency of deficiency, and its association with serum levels of hcys, insulin resistance, inflammatory markers, cutaneous microvascular reactivity and retinal vascular diameters in KTR. Observational, cross-sectional and longitudinal study conducted with adult KTR (18-65 years) at least 6 months after kidney transplantation (KTx). Were exluded patients with AIDS, cancer and autoimmune diseases, amputees, under dialysis therapy and using B12 supplements. Laboratory tests performed at baseline: glucose, insulin, B12, hcys, adiponectin, tumor necrosis factor-α, interleukin-8 and C-reactive protein (CRP). After 2 years the KTRs were submitted to the evaluation of laboratory parameters: glucose, insulin, B12, hcys, leptin and CRP; cutaneous microvascular reactivity by Laser Speckle Contrast Imaging; and the diameter of the retinal vessels by nonmidriatic retinography. Glomerular filtration rate was estimated (eGFR; ml/min) by the CKD-EPI equation. Serum B12 concentration at baseline was used to assess the association with all other variables, and deficiency was defined as < 200pg / mL. At baseline, 218 RTR (121 men), 49 (41–55) years, TxR time 115 (26–171) months and eGFR 52 ± 1.4 ml/min were evaluated. The frequency of B12 deficiency was 14% (n=31). At baseline serum B12: (1) was negatively associated with hcys, even after adjusting for age, sex and time from KTx in patients with eGFR ≥60 (r=-0.54; p=0.01), but after additional adjustment for eGFR the association was no longer significant; (2) was significantly lower in the Hhcys group (428 vs. 246pg / mL, p <0.05); (3) was not associated with insulin resistance and inflammatory markers. After 2 years, 171 patients were reevaluated. The analysis of the association betwenn serum levels of B12 obtained at baseline with the variables obtained after 2 years revealed: (1) negative association with insulin (r=-0.40; p=0.01) and HOMA-IR (r=-0.38; p=0.02) in patients with eGFR < 60 after adjustments for age, sex, time of RTx and eGFR, but after additional adjustment for body mass index the association was no longer significant; (2) negative association, after adjustments for confounders, with CRP in KTR with eGFR ≥ 60 (r=-0.43; p=0.04) and with leptin in the total group (r=-0.26; p=0.04) and in those with eGFR < 60 (r=-0.36; p=0.03); (4) absence of association with serum hcys, cutaneous microvascular reactivity and retinal vascular diameters. The present study suggests that in KTR the frequency of B12 deficiency is high and serum levels of B12 are inversely associated with inflammatory markers in longitudinal analysis |
publishDate |
2019 |
dc.date.issued.fl_str_mv |
2019-11-21 |
dc.date.accessioned.fl_str_mv |
2024-02-07T18:27:05Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/masterThesis |
format |
masterThesis |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
COSTA, Mariana Silva da. Deficiência de vitamina B12 em receptores de transplante renal: frequência e associação com resistência à insulina, biomarcadores inflamatórios e função microvascular. 2019. 117 f. Dissertação (Mestrado em Ciências Médicas) - Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2019. |
dc.identifier.uri.fl_str_mv |
http://www.bdtd.uerj.br/handle/1/21044 |
identifier_str_mv |
COSTA, Mariana Silva da. Deficiência de vitamina B12 em receptores de transplante renal: frequência e associação com resistência à insulina, biomarcadores inflamatórios e função microvascular. 2019. 117 f. Dissertação (Mestrado em Ciências Médicas) - Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2019. |
url |
http://www.bdtd.uerj.br/handle/1/21044 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Universidade do Estado do Rio de Janeiro |
dc.publisher.program.fl_str_mv |
Programa de Pós-Graduação em Ciências Médicas |
dc.publisher.initials.fl_str_mv |
UERJ |
dc.publisher.country.fl_str_mv |
Brasil |
dc.publisher.department.fl_str_mv |
Centro Biomédico::Faculdade de Ciências Médicas |
publisher.none.fl_str_mv |
Universidade do Estado do Rio de Janeiro |
dc.source.none.fl_str_mv |
reponame:Biblioteca Digital de Teses e Dissertações da UERJ instname:Universidade do Estado do Rio de Janeiro (UERJ) instacron:UERJ |
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Universidade do Estado do Rio de Janeiro (UERJ) |
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UERJ |
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UERJ |
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Biblioteca Digital de Teses e Dissertações da UERJ |
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Biblioteca Digital de Teses e Dissertações da UERJ |
bitstream.url.fl_str_mv |
http://www.bdtd.uerj.br/bitstream/1/21044/2/Disserta%C3%A7%C3%A3o+-+Mariana+Silva+da+Costa+-+2019+-+Completa.pdf http://www.bdtd.uerj.br/bitstream/1/21044/1/license.txt |
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repository.name.fl_str_mv |
Biblioteca Digital de Teses e Dissertações da UERJ - Universidade do Estado do Rio de Janeiro (UERJ) |
repository.mail.fl_str_mv |
bdtd.suporte@uerj.br |
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