Frequency and burden of neurological manifestations upon hospital presentation in COVID-19 patients: Findings from a large Brazilian cohort

Detalhes bibliográficos
Autor(a) principal: Marcolino, Milena Soriano
Data de Publicação: 2022
Outros Autores: Anschau, Fernando, Kopittke, Luciane, Pires, Magda Carvalho, Barbosa, Izabela Guimarães, Pereira, Daniella Nunes, Ramos, Lucas Emanuel Ferreira, Assunção, Luís Fernando Israel, Costa, André Soares de Moura, Nogueira, Matheus Carvalho Alves, Duani, Helena, Martins, Karina Paula Medeiros Prado, Moreira, Leila Beltrami, Silva, Carla Thais Cândida Alves da, Oliveira, Neimy Ramos de, Ziegelmann, Patricia Klarmann, Guimarães-Júnior, Milton Henriques, Lima, Mauro Oscar Soares de Souza, Aguiar, Rubia Laura Oliveira, Menezes, Luanna Silva Monteiro, Oliveira, Talita Fischer, Souza, Maíra Dias, Farace, Bárbara Lopes, Cimini, Christiane Corrêa Rodrigues, Maurílio, Amanda de Oliveira, Guimarães, Silvana Mangeon Mereilles, Araújo, Silvia Ferreira, Nascimento, Guilherme Fagundes, Silveira, Daniel Vitório, Ruschel, Karen Brasil, Oliveira, Thainara Conceição de, Schwarzbold, Alexandre Vargas, Nasi, Luiz Antônio, Floriani, Maiara Anschau, Santos, Veridiana Baldon dos, Ramos, Carolina Marques, Alvarenga, Joice Coutinho de, Scotton, Ana Luiza Bahia Alves, Manenti, Euler Roberto Fernandes, Crestani, Gabriela Petry, Batista, Joanna d'Arc Lyra, Ponce, Daniela [UNESP], Machado-Rugolo, Juliana [UNESP], Bezerra, Adriana Falangola Benjamin, Martelli, Petrônio José de Lima, Vianna, Heloisa Reniers, Castro, Luís César de, Medeiros, Cássia Regina Gotler, Vietta, Giovanna Grunewald, Pereira, Elayne Crestani, Chatkin, José Miguel, Godoy, Mariana Frizzo de, Delfino-Pereira, Polianna, Teixeira, Antonio Lucio
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da UNESP
Texto Completo: http://dx.doi.org/10.1016/j.jns.2022.120485
http://hdl.handle.net/11449/247863
Resumo: Background: Scientific data regarding the prevalence of COVID-19 neurological manifestations and prognosis in Latin America countries is still lacking. Therefore, the study aims to understand neurological manifestations of SARS-CoV 2 infection and outcomes in the Brazilian population. Methods: This study is part of the Brazilian COVID-19 Registry, a multicentric cohort, including data from 37 hospitals. For the present analysis, patients were grouped according to the presence of reported symptoms (i.e., headache; anosmia and ageusia; syncope and dizziness) vs. clinically-diagnosed neurological manifestations (clinically-defined neurological syndrome: neurological signs or diagnoses captured by clinical evaluation) and matched with patients without neurological manifestations by age, sex, number of comorbidities, hospital of admission, and whether or not patients had underlying neurological disease. Results: From 6,635 hospitalized patients with COVID-19, 30.8% presented reported neurological manifestations, 10.3% were diagnosed with a neurological syndrome and 60.1% did not show any neurological manifestations. In patients with reported symptoms, the most common ones were headache (20.7%), ageusia (11.1%) and anosmia (8.0%). In patients with neurological syndromes, acute encephalopathy was the most common diagnosis (9.7%). In the matched analysis, patients with neurological syndromes presented more cases of septic shock (17.0 vs. 13.0%, p = 0.045), intensive care unit admission (45.3 vs. 38.9%, p = 0.023), and mortality (38.7 vs. 32.6%, p = 0.026; and 39.2 vs. 30.3%, p < 0.001) when compared to controls. Conclusion: COVID-19 in-hospital patients with clinically defined neurological syndromes presented a higher incidence of septic shock, ICU admission and death when compared to controls.
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spelling Frequency and burden of neurological manifestations upon hospital presentation in COVID-19 patients: Findings from a large Brazilian cohortCOVID-19DeliriumNeurologic manifestationsPrognosisBackground: Scientific data regarding the prevalence of COVID-19 neurological manifestations and prognosis in Latin America countries is still lacking. Therefore, the study aims to understand neurological manifestations of SARS-CoV 2 infection and outcomes in the Brazilian population. Methods: This study is part of the Brazilian COVID-19 Registry, a multicentric cohort, including data from 37 hospitals. For the present analysis, patients were grouped according to the presence of reported symptoms (i.e., headache; anosmia and ageusia; syncope and dizziness) vs. clinically-diagnosed neurological manifestations (clinically-defined neurological syndrome: neurological signs or diagnoses captured by clinical evaluation) and matched with patients without neurological manifestations by age, sex, number of comorbidities, hospital of admission, and whether or not patients had underlying neurological disease. Results: From 6,635 hospitalized patients with COVID-19, 30.8% presented reported neurological manifestations, 10.3% were diagnosed with a neurological syndrome and 60.1% did not show any neurological manifestations. In patients with reported symptoms, the most common ones were headache (20.7%), ageusia (11.1%) and anosmia (8.0%). In patients with neurological syndromes, acute encephalopathy was the most common diagnosis (9.7%). In the matched analysis, patients with neurological syndromes presented more cases of septic shock (17.0 vs. 13.0%, p = 0.045), intensive care unit admission (45.3 vs. 38.9%, p = 0.023), and mortality (38.7 vs. 32.6%, p = 0.026; and 39.2 vs. 30.3%, p < 0.001) when compared to controls. Conclusion: COVID-19 in-hospital patients with clinically defined neurological syndromes presented a higher incidence of septic shock, ICU admission and death when compared to controls.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Department of Internal Medicine Medical School Universidade Federal de Minas Gerais., Av. Professor Alfredo Balena 110Belo HorizonteTelehealth Center University Hospital Universidade Federal de Minas Gerais., Av. Professor Alfredo Balena 190, sala 246Institute for Health Technology Assessment (IATS/ CNPq), R. Ramiro Barcelos, 2359, Prédio 21, Sala 507Grupo Hospitalar Conceição Brazilian National Health System Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor., Av. Francisco Trein, 326Department of Statistics Universidade Federal de Minas Gerais., Av. Presidente Antônio Carlos, 6627, ICEx, sala 4071Mental Health Department Medical School Universidade Federal de Minas Gerais., Av. Professor Alfredo Balena 190sala 246Medical School Universidade Federal de Minas Gerais., Av. Professor Alfredo Balena190Hospitais da Rede Mater Dei., Av. do Contorno, 9000Hospital de Clínicas de Porto Alegre, Av. Protásio Alves, 211Hospital Santo Antônio, Pç. Dr. Márcio Carvalho Lopes Filho, 501Hospital Eduardo de Menezes, R. Dr. Cristiano Rezende, 2213Hospital Tacchini., R. Dr. José Mário Mônaco, 358Hospital Márcio Cunha, Av. Kiyoshi Tsunawaki, 41Hospital Metropolitano Doutor Célio de Castro, R. Dona Luiza, 311Instituto Mário Penna Hospital Luxemburgo., R. Joaquim Cândido Filho, 91Hospital Metropolitano Odilon Behrens, . R. Formiga, 50Hospital Risoleta Tolentino Neves, R. das Gabirobas, 01Hospital Santa Rosália., R. Dr. Onófre, 575Hospital São João de Deus, R. do Cobre, 800Hospital Semper, . Alameda Ezequiel Dias, 389Hospital Unimed BH, Av. do Contorno, 3097Hospital Universitário Canoas, Av. Farroupilha, 8001, Rio Grande do SulHospital Universitário de Santa Maria, Av. Roraima, 1000, Rio Grande do SulHospital Moinhos de Vento, R. Ramiro Barcelos, 910, Rio Grande do SulHospital Julia Kubitschek, Av. Professor Alfredo Balena, 190Hospital João XXIII, Av. Professor Alfredo Balena, 400Hospital Regional Antônio Dias, R. Maj. Gote, 1231Hospital Mãe de Deus, R. José de Alencar, 286Universidade Federal Fronteira do Sul., Av. Fernando Machado, 108EHospital das Clínicas da Faculdade de Medicina de Botucatu, Av. Professor Mário Rubens Guimarães Montenegro, São PauloHospital das Clínicas da Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235Hospital Universitário Ciências Médicas, R. dos Aimorés, 2896Hospital Bruno Born, Av. Benjamin Constant, 881Hospital SOS Cárdio, Rod. SC-401, 121Hospital São Lucas PUCRS, Av. Ipiranga, 6690Faculdade Santa Casa BH, Av. dos Andradas, 2688Neuropsychiatry Program Department of Psychiatry and Behavioral Sciences UT Health Houston, 7000 Fannin StHospital das Clínicas da Faculdade de Medicina de Botucatu, Av. Professor Mário Rubens Guimarães Montenegro, São PauloUniversidade Federal de Minas Gerais (UFMG)Institute for Health Technology Assessment (IATS/ CNPq)Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor.Hospitais da Rede Mater Dei.Hospital de Clínicas de Porto AlegreHospital Santo AntônioHospital Eduardo de MenezesHospital Tacchini.Hospital Márcio CunhaHospital Metropolitano Doutor Célio de CastroHospital Luxemburgo.Hospital Metropolitano Odilon BehrensHospital Risoleta Tolentino NevesHospital Santa Rosália.Hospital São João de DeusHospital SemperHospital Unimed BHHospital Universitário CanoasHospital Universitário de Santa MariaHospital Moinhos de VentoHospital Julia KubitschekHospital João XXIIIHospital Regional Antônio DiasHospital Mãe de DeusUniversidade Federal Fronteira do Sul.Universidade Estadual Paulista (UNESP)Universidade Federal de Pernambuco (UFPE)Hospital Universitário Ciências MédicasHospital Bruno BornHospital SOS CárdioHospital São Lucas PUCRSFaculdade Santa Casa BHUT Health HoustonMarcolino, Milena SorianoAnschau, FernandoKopittke, LucianePires, Magda CarvalhoBarbosa, Izabela GuimarãesPereira, Daniella NunesRamos, Lucas Emanuel FerreiraAssunção, Luís Fernando IsraelCosta, André Soares de MouraNogueira, Matheus Carvalho AlvesDuani, HelenaMartins, Karina Paula Medeiros PradoMoreira, Leila BeltramiSilva, Carla Thais Cândida Alves daOliveira, Neimy Ramos deZiegelmann, Patricia KlarmannGuimarães-Júnior, Milton HenriquesLima, Mauro Oscar Soares de SouzaAguiar, Rubia Laura OliveiraMenezes, Luanna Silva MonteiroOliveira, Talita FischerSouza, Maíra DiasFarace, Bárbara LopesCimini, Christiane Corrêa RodriguesMaurílio, Amanda de OliveiraGuimarães, Silvana Mangeon MereillesAraújo, Silvia FerreiraNascimento, Guilherme FagundesSilveira, Daniel VitórioRuschel, Karen BrasilOliveira, Thainara Conceição deSchwarzbold, Alexandre VargasNasi, Luiz AntônioFloriani, Maiara AnschauSantos, Veridiana Baldon dosRamos, Carolina MarquesAlvarenga, Joice Coutinho deScotton, Ana Luiza Bahia AlvesManenti, Euler Roberto FernandesCrestani, Gabriela PetryBatista, Joanna d'Arc LyraPonce, Daniela [UNESP]Machado-Rugolo, Juliana [UNESP]Bezerra, Adriana Falangola BenjaminMartelli, Petrônio José de LimaVianna, Heloisa ReniersCastro, Luís César deMedeiros, Cássia Regina GotlerVietta, Giovanna GrunewaldPereira, Elayne CrestaniChatkin, José MiguelGodoy, Mariana Frizzo deDelfino-Pereira, PoliannaTeixeira, Antonio Lucio2023-07-29T13:27:56Z2023-07-29T13:27:56Z2022-12-15info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttp://dx.doi.org/10.1016/j.jns.2022.120485Journal of the Neurological Sciences, v. 443.1878-58830022-510Xhttp://hdl.handle.net/11449/24786310.1016/j.jns.2022.1204852-s2.0-85141757629Scopusreponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengJournal of the Neurological Sciencesinfo:eu-repo/semantics/openAccess2024-09-30T17:35:41Zoai:repositorio.unesp.br:11449/247863Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestrepositoriounesp@unesp.bropendoar:29462024-09-30T17:35:41Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false
dc.title.none.fl_str_mv Frequency and burden of neurological manifestations upon hospital presentation in COVID-19 patients: Findings from a large Brazilian cohort
title Frequency and burden of neurological manifestations upon hospital presentation in COVID-19 patients: Findings from a large Brazilian cohort
spellingShingle Frequency and burden of neurological manifestations upon hospital presentation in COVID-19 patients: Findings from a large Brazilian cohort
Marcolino, Milena Soriano
COVID-19
Delirium
Neurologic manifestations
Prognosis
title_short Frequency and burden of neurological manifestations upon hospital presentation in COVID-19 patients: Findings from a large Brazilian cohort
title_full Frequency and burden of neurological manifestations upon hospital presentation in COVID-19 patients: Findings from a large Brazilian cohort
title_fullStr Frequency and burden of neurological manifestations upon hospital presentation in COVID-19 patients: Findings from a large Brazilian cohort
title_full_unstemmed Frequency and burden of neurological manifestations upon hospital presentation in COVID-19 patients: Findings from a large Brazilian cohort
title_sort Frequency and burden of neurological manifestations upon hospital presentation in COVID-19 patients: Findings from a large Brazilian cohort
author Marcolino, Milena Soriano
author_facet Marcolino, Milena Soriano
Anschau, Fernando
Kopittke, Luciane
Pires, Magda Carvalho
Barbosa, Izabela Guimarães
Pereira, Daniella Nunes
Ramos, Lucas Emanuel Ferreira
Assunção, Luís Fernando Israel
Costa, André Soares de Moura
Nogueira, Matheus Carvalho Alves
Duani, Helena
Martins, Karina Paula Medeiros Prado
Moreira, Leila Beltrami
Silva, Carla Thais Cândida Alves da
Oliveira, Neimy Ramos de
Ziegelmann, Patricia Klarmann
Guimarães-Júnior, Milton Henriques
Lima, Mauro Oscar Soares de Souza
Aguiar, Rubia Laura Oliveira
Menezes, Luanna Silva Monteiro
Oliveira, Talita Fischer
Souza, Maíra Dias
Farace, Bárbara Lopes
Cimini, Christiane Corrêa Rodrigues
Maurílio, Amanda de Oliveira
Guimarães, Silvana Mangeon Mereilles
Araújo, Silvia Ferreira
Nascimento, Guilherme Fagundes
Silveira, Daniel Vitório
Ruschel, Karen Brasil
Oliveira, Thainara Conceição de
Schwarzbold, Alexandre Vargas
Nasi, Luiz Antônio
Floriani, Maiara Anschau
Santos, Veridiana Baldon dos
Ramos, Carolina Marques
Alvarenga, Joice Coutinho de
Scotton, Ana Luiza Bahia Alves
Manenti, Euler Roberto Fernandes
Crestani, Gabriela Petry
Batista, Joanna d'Arc Lyra
Ponce, Daniela [UNESP]
Machado-Rugolo, Juliana [UNESP]
Bezerra, Adriana Falangola Benjamin
Martelli, Petrônio José de Lima
Vianna, Heloisa Reniers
Castro, Luís César de
Medeiros, Cássia Regina Gotler
Vietta, Giovanna Grunewald
Pereira, Elayne Crestani
Chatkin, José Miguel
Godoy, Mariana Frizzo de
Delfino-Pereira, Polianna
Teixeira, Antonio Lucio
author_role author
author2 Anschau, Fernando
Kopittke, Luciane
Pires, Magda Carvalho
Barbosa, Izabela Guimarães
Pereira, Daniella Nunes
Ramos, Lucas Emanuel Ferreira
Assunção, Luís Fernando Israel
Costa, André Soares de Moura
Nogueira, Matheus Carvalho Alves
Duani, Helena
Martins, Karina Paula Medeiros Prado
Moreira, Leila Beltrami
Silva, Carla Thais Cândida Alves da
Oliveira, Neimy Ramos de
Ziegelmann, Patricia Klarmann
Guimarães-Júnior, Milton Henriques
Lima, Mauro Oscar Soares de Souza
Aguiar, Rubia Laura Oliveira
Menezes, Luanna Silva Monteiro
Oliveira, Talita Fischer
Souza, Maíra Dias
Farace, Bárbara Lopes
Cimini, Christiane Corrêa Rodrigues
Maurílio, Amanda de Oliveira
Guimarães, Silvana Mangeon Mereilles
Araújo, Silvia Ferreira
Nascimento, Guilherme Fagundes
Silveira, Daniel Vitório
Ruschel, Karen Brasil
Oliveira, Thainara Conceição de
Schwarzbold, Alexandre Vargas
Nasi, Luiz Antônio
Floriani, Maiara Anschau
Santos, Veridiana Baldon dos
Ramos, Carolina Marques
Alvarenga, Joice Coutinho de
Scotton, Ana Luiza Bahia Alves
Manenti, Euler Roberto Fernandes
Crestani, Gabriela Petry
Batista, Joanna d'Arc Lyra
Ponce, Daniela [UNESP]
Machado-Rugolo, Juliana [UNESP]
Bezerra, Adriana Falangola Benjamin
Martelli, Petrônio José de Lima
Vianna, Heloisa Reniers
Castro, Luís César de
Medeiros, Cássia Regina Gotler
Vietta, Giovanna Grunewald
Pereira, Elayne Crestani
Chatkin, José Miguel
Godoy, Mariana Frizzo de
Delfino-Pereira, Polianna
Teixeira, Antonio Lucio
author2_role author
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author
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author
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author
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author
author
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author
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author
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dc.contributor.none.fl_str_mv Universidade Federal de Minas Gerais (UFMG)
Institute for Health Technology Assessment (IATS/ CNPq)
Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor.
Hospitais da Rede Mater Dei.
Hospital de Clínicas de Porto Alegre
Hospital Santo Antônio
Hospital Eduardo de Menezes
Hospital Tacchini.
Hospital Márcio Cunha
Hospital Metropolitano Doutor Célio de Castro
Hospital Luxemburgo.
Hospital Metropolitano Odilon Behrens
Hospital Risoleta Tolentino Neves
Hospital Santa Rosália.
Hospital São João de Deus
Hospital Semper
Hospital Unimed BH
Hospital Universitário Canoas
Hospital Universitário de Santa Maria
Hospital Moinhos de Vento
Hospital Julia Kubitschek
Hospital João XXIII
Hospital Regional Antônio Dias
Hospital Mãe de Deus
Universidade Federal Fronteira do Sul.
Universidade Estadual Paulista (UNESP)
Universidade Federal de Pernambuco (UFPE)
Hospital Universitário Ciências Médicas
Hospital Bruno Born
Hospital SOS Cárdio
Hospital São Lucas PUCRS
Faculdade Santa Casa BH
UT Health Houston
dc.contributor.author.fl_str_mv Marcolino, Milena Soriano
Anschau, Fernando
Kopittke, Luciane
Pires, Magda Carvalho
Barbosa, Izabela Guimarães
Pereira, Daniella Nunes
Ramos, Lucas Emanuel Ferreira
Assunção, Luís Fernando Israel
Costa, André Soares de Moura
Nogueira, Matheus Carvalho Alves
Duani, Helena
Martins, Karina Paula Medeiros Prado
Moreira, Leila Beltrami
Silva, Carla Thais Cândida Alves da
Oliveira, Neimy Ramos de
Ziegelmann, Patricia Klarmann
Guimarães-Júnior, Milton Henriques
Lima, Mauro Oscar Soares de Souza
Aguiar, Rubia Laura Oliveira
Menezes, Luanna Silva Monteiro
Oliveira, Talita Fischer
Souza, Maíra Dias
Farace, Bárbara Lopes
Cimini, Christiane Corrêa Rodrigues
Maurílio, Amanda de Oliveira
Guimarães, Silvana Mangeon Mereilles
Araújo, Silvia Ferreira
Nascimento, Guilherme Fagundes
Silveira, Daniel Vitório
Ruschel, Karen Brasil
Oliveira, Thainara Conceição de
Schwarzbold, Alexandre Vargas
Nasi, Luiz Antônio
Floriani, Maiara Anschau
Santos, Veridiana Baldon dos
Ramos, Carolina Marques
Alvarenga, Joice Coutinho de
Scotton, Ana Luiza Bahia Alves
Manenti, Euler Roberto Fernandes
Crestani, Gabriela Petry
Batista, Joanna d'Arc Lyra
Ponce, Daniela [UNESP]
Machado-Rugolo, Juliana [UNESP]
Bezerra, Adriana Falangola Benjamin
Martelli, Petrônio José de Lima
Vianna, Heloisa Reniers
Castro, Luís César de
Medeiros, Cássia Regina Gotler
Vietta, Giovanna Grunewald
Pereira, Elayne Crestani
Chatkin, José Miguel
Godoy, Mariana Frizzo de
Delfino-Pereira, Polianna
Teixeira, Antonio Lucio
dc.subject.por.fl_str_mv COVID-19
Delirium
Neurologic manifestations
Prognosis
topic COVID-19
Delirium
Neurologic manifestations
Prognosis
description Background: Scientific data regarding the prevalence of COVID-19 neurological manifestations and prognosis in Latin America countries is still lacking. Therefore, the study aims to understand neurological manifestations of SARS-CoV 2 infection and outcomes in the Brazilian population. Methods: This study is part of the Brazilian COVID-19 Registry, a multicentric cohort, including data from 37 hospitals. For the present analysis, patients were grouped according to the presence of reported symptoms (i.e., headache; anosmia and ageusia; syncope and dizziness) vs. clinically-diagnosed neurological manifestations (clinically-defined neurological syndrome: neurological signs or diagnoses captured by clinical evaluation) and matched with patients without neurological manifestations by age, sex, number of comorbidities, hospital of admission, and whether or not patients had underlying neurological disease. Results: From 6,635 hospitalized patients with COVID-19, 30.8% presented reported neurological manifestations, 10.3% were diagnosed with a neurological syndrome and 60.1% did not show any neurological manifestations. In patients with reported symptoms, the most common ones were headache (20.7%), ageusia (11.1%) and anosmia (8.0%). In patients with neurological syndromes, acute encephalopathy was the most common diagnosis (9.7%). In the matched analysis, patients with neurological syndromes presented more cases of septic shock (17.0 vs. 13.0%, p = 0.045), intensive care unit admission (45.3 vs. 38.9%, p = 0.023), and mortality (38.7 vs. 32.6%, p = 0.026; and 39.2 vs. 30.3%, p < 0.001) when compared to controls. Conclusion: COVID-19 in-hospital patients with clinically defined neurological syndromes presented a higher incidence of septic shock, ICU admission and death when compared to controls.
publishDate 2022
dc.date.none.fl_str_mv 2022-12-15
2023-07-29T13:27:56Z
2023-07-29T13:27:56Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://dx.doi.org/10.1016/j.jns.2022.120485
Journal of the Neurological Sciences, v. 443.
1878-5883
0022-510X
http://hdl.handle.net/11449/247863
10.1016/j.jns.2022.120485
2-s2.0-85141757629
url http://dx.doi.org/10.1016/j.jns.2022.120485
http://hdl.handle.net/11449/247863
identifier_str_mv Journal of the Neurological Sciences, v. 443.
1878-5883
0022-510X
10.1016/j.jns.2022.120485
2-s2.0-85141757629
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv Journal of the Neurological Sciences
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.source.none.fl_str_mv Scopus
reponame:Repositório Institucional da UNESP
instname:Universidade Estadual Paulista (UNESP)
instacron:UNESP
instname_str Universidade Estadual Paulista (UNESP)
instacron_str UNESP
institution UNESP
reponame_str Repositório Institucional da UNESP
collection Repositório Institucional da UNESP
repository.name.fl_str_mv Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)
repository.mail.fl_str_mv repositoriounesp@unesp.br
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