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o que indica um processo imune no curso dessa doen&#231;a e que as c&#233;lulas T CD8 mostraram desempenhar um importante papel imunorregulat&#243;rio na patog&#234;nese&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">As c&#233;lulas B desempenham papeis como apresenta&#231;&#227;o de ant&#237;genos&#44; produ&#231;&#227;o de citocina e regula&#231;&#227;o da organog&#234;nese linfoide&#44; diferencia&#231;&#227;o de c&#233;lulas T e fun&#231;&#227;o de c&#233;lulas dendr&#237;ticas&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">4</span></a> Assim&#44; os pap&#233;is essenciais das c&#233;lulas B foram demonstrados em v&#225;rias doen&#231;as mediadas pelo sistema imunol&#243;gico&#46; Como as c&#233;lula B s&#227;o rigorosamente reguladas pela transdu&#231;&#227;o de sinal por meio do receptor de c&#233;lula B e dos receptores da superf&#237;cie celular funcionalmente interrelacionados&#44; como CD19&#44; CD21&#44; CD22&#44; CD40&#44; isso pode ser uma poss&#237;vel estrat&#233;gia para regula&#231;&#227;o dessas doen&#231;as&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">5&#44;6</span></a> Dentre eles&#44; o CD19 geralmente &#233; considerado um regulador de resposta positiva de c&#233;lulas B&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">O n&#237;vel de albumina plasm&#225;tica pode diminuir em condi&#231;&#245;es inflamat&#243;rias&#46; A hipoalbuminemia reduz a press&#227;o onc&#243;tica do plasma e pode contribuir para o surgimento de edema pulmonar na presen&#231;a de press&#227;o atrial esquerda elevada e contribuir para a progress&#227;o da insufici&#234;ncia card&#237;aca&#44; e &#233; comumente vista em pacientes com insufici&#234;ncia card&#237;aca&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">8</span></a> V&#225;rios estudos demonstraram uma baixa taxa de sobrevida e uma alta taxa de morte cardiovascular em pacientes com hipoalbuminemia &#40;&#60; 3&#44;4<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#41;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a> e um estudo enfatizou a albumina s&#233;rica &#60;<span class="elsevierStyleHsp" style=""></span>2&#44;5<span class="elsevierStyleHsp" style=""></span>g&#47;dl como a vari&#225;vel preditora mais independente de mortalidade hospitalar&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a> Por&#233;m&#44; a rela&#231;&#227;o albumina&#8208;FRA nunca foi investigada para doen&#231;a valvular cr&#244;nica em crian&#231;as&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Este estudo visou a definir os preditores de cardite cr&#244;nica por meio da avalia&#231;&#227;o de eletrocardiograma&#44; ecocardiografia&#44; an&#225;lise do subgrupo de linf&#243;citos e par&#226;metros laboratoriais&#44; incluindo albumina&#44; taxa de sedimenta&#231;&#227;o de eritr&#243;citos &#40;TSE&#41;&#44; hemograma completo e ASO&#44; em pacientes diagnosticados com cardite reum&#225;tica aguda antes do tratamento com esteroides&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material e m&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Foram inclu&#237;dos no estudo retrospectivo 22 pacientes internados na unidade de cardiologia pedi&#225;trica com diagn&#243;stico de cardite reum&#225;tica aguda entre maio de 2010 e maio de 2011&#46; Foram feitos hemograma completo&#44; n&#237;vel de albumina plasm&#225;tica&#44; prote&#237;na C reativa &#40;PCR&#41;&#44; taxa de sedimenta&#231;&#227;o de eritr&#243;citos &#40;TSE&#41;&#44; antiestreptolisina&#8208;O &#40;ASO&#41;&#44; an&#225;lise do subgrupo de linf&#243;citos&#44; ecocardiografia e eletrocardiograma antes do tratamento em pacientes eleg&#237;veis&#46; O estudo foi aprovado pelo conselho de revis&#227;o institucional&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Todos os pacientes com diagn&#243;stico presumido de FRA foram avaliados por ecocardiografia&#44; independentemente dos achados de ausculta card&#237;aca&#46; O diagn&#243;stico de FRA teve como base os crit&#233;rios modificados de Jones &#40;dois maiores ou um maior &#8211; dois menores e preditores anteriores de estreptococos hemol&#237;tico beta do Grupo A &#91;GABHS&#93;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a> A regurgita&#231;&#227;o valvular foi considerada patol&#243;gica quando a extens&#227;o de um jato colorido foi de no m&#237;nimo 1<span class="elsevierStyleHsp" style=""></span>cm&#44; visto em pelo menos dois planos separados com um pico de velocidade superior a 2&#44;5 m&#47;s no exame de ecocardiografia&#46; Os pacientes que foram diagnosticados com CRA pela primeira vez foram inclu&#237;dos no estudo&#46; Os pacientes com diagn&#243;stico pr&#233;vio de FRA e&#47;ou CRA n&#227;o foram inclu&#237;dos&#46; Assim&#44; prednisona a 2<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d &#40;m&#225;ximo de 60<span class="elsevierStyleHsp" style=""></span>mg&#41; foi iniciada para todos os pacientes&#46; Ap&#243;s 2&#8208;4 semanas de prednisona&#44; a dose foi reduzida ao longo de duas semanas&#46; &#193;cido acetilsalic&#237;lico foi acrescentado ao tratamento durante a redu&#231;&#227;o do esteroide a uma dose de 90&#8208;100<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d &#40;m&#225;ximo de 3&#44;5<span class="elsevierStyleHsp" style=""></span>g&#41; e foi interrompido ap&#243;s afunilamento com uma dura&#231;&#227;o total de quatro semanas&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Uma inje&#231;&#227;o de 1&#46;200&#46;000 U de penicilina G benzatina em pacientes que pesam mais de 27<span class="elsevierStyleHsp" style=""></span>kg e 600&#46;000 U intramuscular em pacientes que pesam 27<span class="elsevierStyleHsp" style=""></span>kg ou menos a cada tr&#234;s semanas &#233; o esquema recomendado para preven&#231;&#227;o secund&#225;ria&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">No momento do diagn&#243;stico&#44; oito pacientes apresentaram regurgita&#231;&#227;o leve&#46; Regurgita&#231;&#227;o moderada e grave esteve presente em oito e seis pacientes&#44; respectivamente&#46; Nenhum apresentou epis&#243;dio recorrente de cardite durante o per&#237;odo de acompanhamento&#46; Ap&#243;s a terapia com esteroides&#44; as provas de fase aguda continuaram negativas durante todo o estudo&#46; Os pacientes foram divididos em dois grupos como aqueles com &#40;Grupo 1&#41; e sem &#40;Grupo&#41; regress&#227;o na regurgita&#231;&#227;o valvular&#44; de acordo com a avalia&#231;&#227;o ecocardiogr&#225;fica no 6&#176; m&#234;s ap&#243;s o tratamento&#44; e os dados desses grupos no diagn&#243;stico inicial foram comparados&#46; Foi concedido acesso &#224; base de dados do hospital por sua administra&#231;&#227;o&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Ecocardiografia</span><p id="par0045" class="elsevierStylePara elsevierViewall">Os exames de ecocardiografia transtor&#225;cica bidimensional e com Doppler dos indiv&#237;duos foram feitos com o aparelho Vivid 3<span class="elsevierStyleHsp" style=""></span>da GE &#40;GE Healthcare&#44; WI&#44; EUA&#41;&#44; com o uso de transdutores de 3<span class="elsevierStyleHsp" style=""></span>MHz e 7<span class="elsevierStyleHsp" style=""></span>MHz na avalia&#231;&#227;o card&#237;aca&#46; As medi&#231;&#245;es ecocardiogr&#225;ficas em modo M foram obtidas a partir do n&#237;vel da v&#225;lvula mitral posterior&#44; de acordo com as recomenda&#231;&#245;es da Sociedade Americana de Ecocardiografia&#46; A gravidade da regurgita&#231;&#227;o valvular foi avaliada por ecocardiografia com Doppler colorido com o uso da largura e da extens&#227;o do fluxo do jato&#46; Os crit&#233;rios para regurgita&#231;&#227;o valvular com o uso de planos ortogonais foram um jato colorido verificado em pelo menos dois planos separados&#44; a extens&#227;o de um jato colorido de no m&#237;nimo 1<span class="elsevierStyleHsp" style=""></span>cm e um jato colorido em mosaico com um pico de velocidade superior a 2&#44;5 m&#47;s&#46; A gravidade da regurgita&#231;&#227;o mitral e da regurgita&#231;&#227;o a&#243;rtica foi classificada qualitativamente de 1 a 4 a depender do fluxo do jato de regurgita&#231;&#227;o observado no &#225;trio esquerdo ou no ventr&#237;culo esquerdo por ecocardiografia com Doppler colorido&#46; A regurgita&#231;&#227;o mitral e a regurgita&#231;&#227;o a&#243;rtica detectadas pelo Doppler colorido foram consideradas grau 1 se o comprimento do jato tivesse 1&#44;5<span class="elsevierStyleHsp" style=""></span>cm&#59; grau 2 se 1&#44;5&#8208;2&#44;9<span class="elsevierStyleHsp" style=""></span>cm&#59; grau 3 se 3&#8208;4&#44;4<span class="elsevierStyleHsp" style=""></span>cm&#59; e grau 4 se 4&#44;5<span class="elsevierStyleHsp" style=""></span>cm&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">12</span></a> O grau 1 foi considerado leve&#44; o grau 2 moderado e os graus 3 e 4 regurgita&#231;&#227;o grave&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">13&#44;14</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Eletrocardiograma</span><p id="par0050" class="elsevierStylePara elsevierViewall">Foram obtidas grava&#231;&#245;es de ECG de superf&#237;cie de 12 deriva&#231;&#245;es de todos os pacientes&#46; O intervalo QT foi medido do in&#237;cio da onda Q at&#233; o fim da onda T&#46; Quando a onda U esteve presente&#44; o fim da onda T foi definido como o ponto mais baixo entre as ondas T e U&#46; A dispers&#227;o QT foi definida como a diferen&#231;a entre os intervalos QT m&#225;ximos e m&#237;nimos no ECG padr&#227;o de 12 canais&#46; Os intervalos QT nos ECGs foram corrigidos com a f&#243;rmula de Bazett &#40;QTc &#61; QT&#47; &#8730;R &#8211; R&#41; e foram expressos como QTc&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">15</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Citometria de fluxo</span><p id="par0055" class="elsevierStylePara elsevierViewall">Os subgrupos de linf&#243;citos foram medidos com o m&#233;todo de imunofluoresc&#234;ncia indireta&#44; com o uso de anticorpos monoclonais&#46; O m&#233;todo envolve as etapas de colora&#231;&#227;o com anticorpos monoclonais&#44; incuba&#231;&#227;o&#44; remo&#231;&#227;o de eritr&#243;citos e fixa&#231;&#227;o do material com paraformalde&#237;do&#46; Os anticorpos monoclonais s&#227;o preparados na forma de um painel e cont&#234;m fluorocromo&#46; H&#225; v&#225;rios fluorocromos com diferentes caracter&#237;sticas espectrais&#59; as c&#233;lulas ou part&#237;culas em suspens&#227;o passam por uma c&#226;mara iluminada por uma luz laser e os sinais emitidos pelas c&#233;lulas conforme sua passagem pela luz s&#227;o coletados e analisados&#46; A fonte dos sinais pode ser as caracter&#237;sticas f&#237;sicas da c&#233;lula&#44; como a magnitude e a granularidade&#44; bem como v&#225;rios fluorocromos ligados &#224; c&#233;lula&#46; Assim&#44; os dados podem ser coletados com rela&#231;&#227;o &#224;s v&#225;rias propriedades da c&#233;lula ou da part&#237;cula&#44; como imunofenotipagem&#44; conte&#250;do de DNA&#44; atividades enzim&#225;ticas&#44; potencial e viabilidade da membrana celular&#46; A presen&#231;a de uma entidade &#40;&#61; ant&#237;geno&#41; na c&#233;lula pode ser demonstrada imunologicamente pelo m&#233;todo de imuno&#8208;histoqu&#237;mica por meio de uma mancha&#47;uma enzina ligada a uma prote&#237;na produzida em resposta a essa entidade &#40;&#61; anticorpo&#41; ou por microscopia de imunofluoresc&#234;ncia por meio de uma subst&#226;ncia fluorescente&#46; Os ant&#237;genos da superf&#237;cie celular s&#227;o definidos com a terminologia &#8220;Agrupamento de Diferencia&#231;&#227;o&#44; CD&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">16</span></a> As amostras de sangue foram testadas no laborat&#243;rio de hematologia&#46; A an&#225;lise da citometria de fluxo foi feita com sangue coletado em tubos com &#225;cido etilendiaminotetraac&#233;tico &#40;2<span class="elsevierStyleHsp" style=""></span>mg&#47;mL&#41;&#44; com um aparelho FC 500<span class="elsevierStyleHsp" style=""></span>da Beckman Coulter &#40;Beckman Coulter Life Sciences&#44; IN&#44; USA&#41;&#46; Os percentuais de CD3&#44; CD4&#44; CD8 e CD19 s&#227;o calculados&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Testes de laborat&#243;rio</span><p id="par0060" class="elsevierStylePara elsevierViewall">Conhecidos como marcadores de inflama&#231;&#227;o e identificados como fatores de risco independentes para insufici&#234;ncia card&#237;aca em doen&#231;as reum&#225;ticas&#44; foram estudados a prote&#237;na C reativa &#40;PCR&#41; e a taxa de sedimenta&#231;&#227;o de eritr&#243;citos &#40;TSE&#41;&#59;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a> albumina plasm&#225;tica&#44; um indicador negativo de inflama&#231;&#227;o associado a mortalidade card&#237;aca&#59;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a> n&#237;vel de antiestreptolisinas &#40;ASO&#41; como um indicador de infe&#231;&#227;o por GABHS&#46; O m&#233;todo colorim&#233;trico verde de bromocresol foi usado para avaliar os n&#237;veis de albumina&#46; As concentra&#231;&#245;es de prote&#237;na C reativa &#40;PCR&#41; e os n&#237;veis de ASO foram estudados de forma nefelom&#233;trica com o kit Behring&#46; A sedimenta&#231;&#227;o foi medida com o m&#233;todo de Westergren&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Avalia&#231;&#227;o estat&#237;stica</span><p id="par0065" class="elsevierStylePara elsevierViewall">As an&#225;lises estat&#237;sticas foram feitas com o programa SPSS para Windows 17&#46;0 &#40;SPSS&#44; Chicago&#44; IL&#44; E&#46;U&#46;A&#46;&#41;&#46; A distribui&#231;&#227;o normal das vari&#225;veis foi avaliada com o teste de Kolmogorov&#8208;Smirnov&#46; O teste <span class="elsevierStyleItalic">t</span> de Student foi usado para investigar a relev&#226;ncia das diferen&#231;as entre o controle e os grupos de pacientes da s&#233;rie com distribui&#231;&#227;o regular e o teste U de Mann&#8208;Whitney foi usado para a s&#233;rie com distribui&#231;&#227;o irregular&#46; Os valores de p abaixo de 0&#44;05 foram considerados estatisticamente significativos&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Resultados</span><p id="par0070" class="elsevierStylePara elsevierViewall">Foram inclu&#237;dos no estudo 22 pacientes &#40;12 meninos&#44; 10 meninas&#44; com m&#233;dia de 12&#44;23<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;1 anos&#41; diagnosticados com cardite reum&#225;tica aguda&#46; Nenhum com cardite apresentou coreia de Sydenham&#44; eritema marginado nem n&#243;dulos subcut&#226;neos&#46; Os dados cl&#237;nicos e laboratoriais detalhados s&#227;o apresentados na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46; A avalia&#231;&#227;o ecocardiogr&#225;fica e eletrocardiogr&#225;fica revelou a m&#233;dia da fra&#231;&#227;o de encurtamento&#44; a frequ&#234;ncia card&#237;aca m&#233;dia&#44; a dispers&#227;o QTc e o intervalo PR em termos de &#37;&#44; 42&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;5&#44; 91&#44;10<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#44;27&#47;min&#44; 42&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#44;5<span class="elsevierStyleHsp" style=""></span>ms&#44; 0&#44;15<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;04 s&#44; respectivamente &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46; As caracter&#237;sticas eletrocardiogr&#225;ficas n&#227;o demonstraram diferen&#231;a em termos de intervalo PR&#44; frequ&#234;ncia card&#237;aca m&#233;dia e dispers&#227;o QTc entre o Grupo 1 e Grupo 2 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Testes de sangue de rotina n&#227;o demonstraram associa&#231;&#227;o nos n&#237;veis de hemoglobina&#44; sedimenta&#231;&#227;o e anticorpo ASO entre o Grupo 1 e o Grupo 2&#44; ao passo que o n&#237;vel de albumina no sangue no diagn&#243;stico foi encontrado significativamente menor no Grupo 2 &#40;2&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;48&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o ecocardiogr&#225;fica revelou um comprometimento combinado da v&#225;lvula em 68&#44;2&#37; dos pacientes&#44; regurgita&#231;&#227;o mitral isolada em 22&#44;7&#37; e regurgita&#231;&#227;o a&#243;rtica isolada em 9&#44;1&#37;&#59; 17 &#40;77&#44;2&#37;&#41; pacientes apresentaram regress&#227;o da patologia valvular&#44; ao passo que em cinco &#40;22&#44;8&#37;&#41; o grau de regurgita&#231;&#227;o &#40;regurgita&#231;&#227;o moderada em um &#91;4&#44;6&#37;&#93; e regurgita&#231;&#227;o grave em quatro &#91;18&#44;2&#37;&#93;&#41; continuou inalterado &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46; No momento do diagn&#243;stico&#44; oito pacientes apresentaram regurgita&#231;&#227;o leve&#46; Regurgita&#231;&#227;o moderada e grave estiveram presentes em oito e seis pacientes&#44; respectivamente&#46; Houve desaparecimento da regurgita&#231;&#227;o moderada inicial em oito pacientes &#40;36&#44;3&#37;&#41; no 6&#176; m&#234;s de acompanhamento&#46; Entre sete &#40;31&#44;8&#37;&#41; pacientes com regurgita&#231;&#227;o moderada inicialmente&#44; a regurgita&#231;&#227;o desapareceu em tr&#234;s e quatro pacientes apresentaram melhoria para regurgita&#231;&#227;o leve&#46; Dois pacientes com regurgita&#231;&#227;o grave inicialmente apresentaram melhoria para regurgita&#231;&#227;o moderada &#40;9&#44;1&#37;&#41;&#46; Em cinco &#40;22&#44;8&#37;&#41; pacientes&#44; o grau de regurgita&#231;&#227;o &#40;regurgita&#231;&#227;o moderada em um &#91;4&#44;6&#37;&#93; e regurgita&#231;&#227;o grave em quatro &#91;18&#44;2&#93;&#41; continuou inalterado&#46; O destino do comprometimento valvular em todos os pacientes estudados encontra&#8208;se representado na <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">A an&#225;lise do subgrupo de linf&#243;citos mostrou linfopenia em 31&#44;8&#37; &#40;sete&#41; dos pacientes&#46; Os linf&#243;citos T CD3 e CD4 apresentaram redu&#231;&#227;o em 40&#44;9&#37; &#40;nove&#41; dos pacientes&#46; Adicionalmente&#44; os linf&#243;citos T CD8 tamb&#233;m apresentaram redu&#231;&#227;o em 13&#44;6&#37; dos pacientes com n&#237;veis reduzidos de CD3 e CD4&#46; O percentual de CD8 no diagn&#243;stico reduziu significativamente no Grupo 2&#44; ao passo que houve um aumento significativo no percentual de CD19 &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discuss&#227;o</span><p id="par0090" class="elsevierStylePara elsevierViewall">V&#225;rios ant&#237;genos com similaridade &#224;s prote&#237;nas M estreptococos hemol&#237;tico beta do Grupo A foram identificados em indiv&#237;duos suscet&#237;veis&#58; epitopos da miosina card&#237;aca&#44; vimentina&#44; laminina e outras prote&#237;nas intracelulares&#46; Essa similaridade causa reatividade cruzada&#44; leva a rea&#231;&#245;es autoimunes e pode resultar em dano do mioc&#225;rdio&#46; Assim&#44; v&#225;rios estudos tentaram definir essas a&#231;&#245;es por meio da investiga&#231;&#227;o de subgrupos de linf&#243;citos&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">18</span></a> Ratos imunizados com prote&#237;na M5 estreptoc&#243;cica desenvolveram les&#245;es nas v&#225;lvulas card&#237;acas&#59; c&#233;lulas T CD4 &#40;&#43;&#41; e macr&#243;fagos CD68 &#40;&#43;&#41;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a> foram detectados em infiltra&#231;&#245;es e infiltra&#231;&#227;o predominante de linf&#243;citos T de CD4 foi encontrada em bi&#243;psias de tecidos do cora&#231;&#227;o de pacientes submetidos a cirurgia valvular devido a cardite reum&#225;tica&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">20</span></a> Os pacientes com febre reum&#225;tica aguda e cardite reum&#225;tica aguda apresentaram aumento significativo nos linf&#243;citos T CD4&#44; linf&#243;citos B CD22 e na raz&#227;o CD4&#58;CD8 e redu&#231;&#227;o significativa nos linf&#243;citos T CD8 e CD3&#44; em compara&#231;&#227;o aos pacientes com cardite reum&#225;tica cr&#244;nica&#44; faringite estreptoc&#243;cica e indiv&#237;duos saud&#225;veis&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">2</span></a> Constatou&#8208;se que a redu&#231;&#227;o no CD8 estava associada &#224; atividade reum&#225;tica em estudos anteriores&#46; No presente estudo&#44; os linf&#243;citos T CD8 no sangue perif&#233;rico no diagn&#243;stico inicial eram &#60;<span class="elsevierStyleHsp" style=""></span>20&#44;56<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;9&#37; no grupo sem recupera&#231;&#227;o das les&#245;es nas v&#225;lvulas card&#237;acas e esse achado foi considerado um importante indicador para o grupo sem regress&#227;o na cardite&#46; O resultado de nosso estudo pode ser atribu&#237;do ao fato de que apenas as c&#233;lulas T CD8 podem causar anergia aos superant&#237;genos estreptococos hemol&#237;tico beta do Grupo A e podem&#44; assim&#44; desempenhar um importante papel imunorregulat&#243;rio na patog&#234;nese da doen&#231;a&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">21</span></a> No presente estudo&#44; a raz&#227;o CD4&#58;CD8 aumentou no grupo sem recupera&#231;&#227;o nos achados valvulares&#44; em compara&#231;&#227;o com o grupo sem recupera&#231;&#227;o&#59; contudo&#44; a diferen&#231;a n&#227;o foi estatisticamente significativa&#46; O percentual de c&#233;lulas B positivas para CD19 foi significativamente elevado nos pacientes com FRA&#44; o que sugere um papel dos linf&#243;citos B na inflama&#231;&#227;o e&#47;ou autoimunidade na patog&#234;nese dessa doen&#231;a&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">22</span></a> Nosso estudo demonstrou menor n&#237;vel do CD8 no Grupo 2 do que no Grupo 1 e maior n&#237;vel do CD19 no Grupo 2 do que no Grupo 1 no diagn&#243;stico&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Um estudo feito por Saito et al&#46; demonstrou que os pacientes com esclerose sist&#234;mica superexpressaram o CD19&#44; uma importante mol&#233;cula reguladora expressa pelos linf&#243;citos B&#46; As c&#233;lulas B dos ratos com defici&#234;ncia de CD19 s&#227;o hiporresponsivas a sinais transmembranares&#44; ao passo que as c&#233;lulas B que superexpressam s&#227;o hiperrenponsivas e geram autoanticorpos&#46; Assim&#44; uma via de sinaliza&#231;&#227;o dependente de CD19 nas c&#233;lulas B contribui para o desenvolvimento da autoimunidade sist&#234;mica&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a> Um estudo feito por Iwata et al<span class="elsevierStyleItalic">&#46;</span> &#233; o primeiro a demonstrar que as c&#233;lulas B desempenham um papel fundamental no processo de cicatriza&#231;&#227;o de feridas&#46; A express&#227;o de CD19 regula positivamente o processo de cicatriza&#231;&#227;o de feridas&#46; Um atraso na cicatriza&#231;&#227;o de feridas em ratos com CD19&#8208;&#47;&#8208; foi associado a redu&#231;&#227;o na infiltra&#231;&#227;o de neutr&#243;filos e macr&#243;fagos&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">24</span></a> No presente estudo&#44; o percentual de CD8 no diagn&#243;stico reduziu significativamente nos pacientes com CRA sem recupera&#231;&#227;o no comprometimento valvular&#44; ao passo que houve uma aumento significativo no percentual de CD19&#46; Devido ao papel dos linf&#243;citos CD8 e CD19 &#40;&#43;&#41; na autoimunidade e na inflama&#231;&#227;o&#44; acreditamos que a altera&#231;&#227;o desses dois subgrupos de linf&#243;citos pode ter um papel na patog&#234;nese e na previs&#227;o de comprometimento valvular cr&#244;nico em pacientes com FRA&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">O n&#237;vel de albumina no sangue pode reduzir em condi&#231;&#245;es inflamat&#243;rias e insufici&#234;ncia card&#237;aca&#46; As poss&#237;veis causas de redu&#231;&#227;o nos n&#237;veis de albumina no sangue na insufici&#234;ncia card&#237;aca incluem redu&#231;&#227;o da s&#237;ntese devido a congest&#227;o hep&#225;tica&#44; aumento na atividade metab&#243;lica&#44; inflama&#231;&#227;o e protein&#250;ria&#46; Para hipoalbuminemia&#44; os n&#237;veis &#60;<span class="elsevierStyleHsp" style=""></span>3&#44;5<span class="elsevierStyleHsp" style=""></span>g&#47;dl t&#234;m demonstrado ser um risco e a albumina &#60;<span class="elsevierStyleHsp" style=""></span>2&#44;5<span class="elsevierStyleHsp" style=""></span>g&#47;dl tem demonstrado ser um fator de risco independente em doen&#231;as card&#237;acas&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a> No presente estudo&#44; o n&#237;vel de albumina no sangue no diagn&#243;stico foi de 2&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;48 no grupo sem recupera&#231;&#227;o em les&#245;es valvulares ap&#243;s o 6&#176; m&#234;s de acompanhamento ap&#243;s o diagn&#243;stico de cardite ativa e isso foi significativamente menor em compara&#231;&#227;o com o grupo com recupera&#231;&#227;o em les&#245;es valvulares&#46; Como o exame f&#237;sico dos pacientes n&#227;o mostrou edema e mostrou percentis de estatura&#8208;peso normais e os testes da fun&#231;&#227;o hep&#225;tica tamb&#233;m se mostraram normais&#44; esse resultado n&#227;o foi&#44; na maior parte do tempo&#44; associado ao maior n&#237;vel de inflama&#231;&#227;o e gravidade da regurgita&#231;&#227;o valvular&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Um aumento na dispers&#227;o QT pode refletir o comprometimento card&#237;aco na febre reum&#225;tica e ser um importante par&#226;metro no diagn&#243;stico e na decis&#227;o terap&#234;utica sobre a cardite reum&#225;tica&#46; Os pesquisadores revelaram que a dispers&#227;o QT &#233; maior com uma patologia valvular mais grave em pacientes com CRA&#46; Foi descoberto que a dispers&#227;o QT reduziu ap&#243;s a fase inicial da CRA&#44; o que reflete uma melhoria eletrofisiol&#243;gica nesse subgrupo de pacientes&#46; Essas observa&#231;&#245;es sugeriram que a dispers&#227;o QT aumenta em associa&#231;&#227;o com o comprometimento card&#237;aco em crian&#231;as sem febre reum&#225;tica aguda&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a> Contudo&#44; quando comparado com a dispers&#227;o QTc em pacientes com CRA sem recupera&#231;&#227;o nos achados valvulares no grupo sem recupera&#231;&#227;o&#44; a dispers&#227;o QTc n&#227;o foi estatisticamente diferente&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Machado et al&#46; revelaram que os n&#237;veis de ASO foram significativamente maiores em pacientes com FRA&#44; em compara&#231;&#227;o com aqueles com coreia de Sydenham&#44; artrite idiop&#225;tica e amigdalofaringite recorrente&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">26</span></a> Contudo&#44; em nosso estudo&#44; ao comparar os n&#237;veis de ASO em pacientes com CRA sem recupera&#231;&#227;o nos achados valvulares com o grupo sem recupera&#231;&#227;o&#44; os n&#237;veis de ASO n&#227;o podem predizer a persist&#234;ncia da patologia valvular em pacientes com CRA&#46; Al&#233;m disso&#44; os n&#237;veis de PCR e sedimenta&#231;&#227;o n&#227;o predisseram a persist&#234;ncia da patologia valvular nesse subgrupo de pacientes&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Alguns estudos tentaram estabelecer os fatores de risco para cardite cr&#244;nica e o di&#226;metro diast&#243;lico final do ventr&#237;culo esquerdo inicial&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">27</span></a> A presen&#231;a de polimorfismo do TNF&#8208;&#945; 308G<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>A&#44;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">28</span></a> a defici&#234;ncia nas c&#233;lulas CD4 para produ&#231;&#227;o de IL4 no tecido da v&#225;lvula card&#237;aca<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">29</span></a> e a presen&#231;a de HLA&#8208;DR7DR53 associado &#224;s mol&#233;culas de DQ foram relatados como poss&#237;veis preditores de cronicidade&#46; No presente estudo&#44; o n&#237;vel de albumina no sangue e os n&#237;veis de CD8&#8208;CD19 no diagn&#243;stico foram verificados como fatores de risco determinantes&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Concluindo&#44; o n&#237;vel de albumina no sangue e&#44; principalmente&#44; a express&#227;o de CD18&#8208;CD19 no diagn&#243;stico s&#227;o &#250;teis na defini&#231;&#227;o do grupo em risco de desenvolver cardite cr&#244;nica em pacientes com cardite reum&#225;tica aguda&#46; S&#227;o necess&#225;rios estudos mais prospectivos e em grande escala para avaliar ainda mais o impacto dos subgrupos de linf&#243;citos para predizer doen&#231;a valvular cr&#244;nica em pacientes com FRA&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Um modelo retrospectivo e tamanho da amostra relativamente pequeno foram as principais limita&#231;&#245;es de nosso estudo&#46; O f&#225;cil acesso a tratamento m&#233;dico e a antibi&#243;ticos e a melhoria da situa&#231;&#227;o socioecon&#244;mica em nosso pa&#237;s podem ter levado ao aumento na incid&#234;ncia de FRA e podem resultar em uma menor coorte de pacientes com CRA&#44; em compara&#231;&#227;o com as d&#233;cadas anteriores&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflitos de interesse</span><p id="par0135" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
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          "titulo" => "Keywords"
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          "titulo" => "Material e m&#233;todos"
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            0 => array:2 [
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              "titulo" => "Ecocardiografia"
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              "titulo" => "Eletrocardiograma"
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              "titulo" => "Citometria de fluxo"
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              "titulo" => "Testes de laborat&#243;rio"
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              "titulo" => "Avalia&#231;&#227;o estat&#237;stica"
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    "fechaRecibido" => "2015-09-23"
    "fechaAceptado" => "2016-01-15"
    "PalabrasClave" => array:2 [
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        0 => array:4 [
          "clase" => "keyword"
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          "palabras" => array:5 [
            0 => "Acute rheumatic carditis"
            1 => "Albumin"
            2 => "CD8"
            3 => "CD19"
            4 => "Lymphocyte subtypes"
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        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras&#8208;chave"
          "identificador" => "xpalclavsec760946"
          "palabras" => array:5 [
            0 => "Cardite reum&#225;tica aguda"
            1 => "Albumina"
            2 => "CD8"
            3 => "CD19"
            4 => "Subtipos de linf&#243;citos"
          ]
        ]
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The aim of this study is to define the predictors of chronic carditis in patients with acute rheumatic carditis &#40;ARC&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patients diagnosed with ARC between May 2010 and May 2011 were included in the study&#46; Echocardiography&#44; electrocardiography&#44; lymphocyte subset analysis&#44; acute phase reactants&#44; plasma albumin levels&#44; and antistreptolysin&#8208;O &#40;ASO&#41; tests were performed at initial presentation&#46; The echocardiographic assessments were repeated at the sixth month of follow&#8208;up&#46; The patients were divided into two groups according to persistence of valvular pathology at 6th month as Group 1 and Group 2&#44; and all clinical and laboratory parameters at admission were compared between two groups of valvular involvement&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">During the one&#8208;year study period&#44; 22 patients had valvular disease&#46; Seventeen &#40;77&#46;2&#37;&#41; patients showed regression in valvular pathology&#46; An initial mild regurgitation disappeared in eight patients &#40;36&#46;3&#37;&#41;&#46; Among seven &#40;31&#46;8&#37;&#41; patients with moderate regurgitation initially&#44; the regurgitation disappeared in three&#44; and four patients improved to mild regurgitation&#46; Two patients with a severe regurgitation initially improved to moderate regurgitation &#40;9&#46;1&#37;&#41;&#46; In five &#40;22&#46;8&#37;&#41; patients&#44; the grade of regurgitation &#91;moderate regurgitation in one &#40;4&#46;6&#37;&#41;&#44; and severe regurgitation in 4 &#40;18&#46;2&#37;&#41;&#93; remained unchanged&#46; The albumin level was significantly lower at diagnosis in Group 2 &#40;2&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;48<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#41;&#46; Lymphocyte subset analysis showed a significant decrease in the CD8 percentage and a significant increase in CD19 percentage at diagnosis in Group 2 compared to Group 1&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The blood albumin level and the percentage of CD8 and CD19 &#40;&#43;&#41; lymphocytes at diagnosis may help to predict chronic valvular disease risk in patients with acute rheumatic carditis&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Definir os preditores da cardite cr&#244;nica em pacientes com cardite reum&#225;tica aguda &#40;CRA&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Os pacientes diagnosticados com CRA entre maio de 2010 e maio de 2011 foram inclu&#237;dos no estudo&#46; Foram feitos os testes de ecocardiografia&#44; eletrocardiograma&#44; uma an&#225;lise do subgrupo de linf&#243;citos&#44; provas de fase aguda&#44; n&#237;veis de albumina plasm&#225;tica&#44; antiestreptolisina&#8208;O &#40;ASO&#41; na manifesta&#231;&#227;o inicial&#46; As avalia&#231;&#245;es ecocardiogr&#225;ficas foram repetidas no 6&#176; m&#234;s de acompanhamento&#46; Os pacientes foram divididos em dois grupos de acordo com a persist&#234;ncia da patologia valvular no 6&#176; m&#234;s como Grupo 1 e Grupo 2 e todos os par&#226;metros cl&#237;nicos e laboratoriais na interna&#231;&#227;o foram comparados entre dois grupos de comprometimento valvular&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Durante o per&#237;odo do estudo de um ano&#44; 22 pacientes apresentaram doen&#231;a valvular&#59; 17 &#40;77&#44;2&#37;&#41; apresentaram regress&#227;o da patologia valvular&#46; Houve desaparecimento de regurgita&#231;&#227;o moderada inicial em oito pacientes &#40;36&#44;3&#37;&#41;&#46; Entre sete &#40;31&#44;8&#37;&#41; pacientes com regurgita&#231;&#227;o moderada inicialmente&#44; a regurgita&#231;&#227;o desapareceu em tr&#234;s e quatro apresentaram melhoria para regurgita&#231;&#227;o leve&#46; Dois pacientes com regurgita&#231;&#227;o grave inicialmente apresentaram melhoria para regurgita&#231;&#227;o moderada &#40;9&#44;1&#37;&#41;&#46; Em cinco &#40;22&#44;8&#37;&#41; pacientes o grau de regurgita&#231;&#227;o &#40;regurgita&#231;&#227;o moderada em um &#91;4&#44;6&#37;&#93; e regurgita&#231;&#227;o grave em quatro &#91;18&#44;2&#93;&#41; continuou inalterado&#46; O n&#237;vel de albumina foi significativamente menor no diagn&#243;stico no Grupo 2 &#40;2&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;48 gr&#47;dL&#41;&#46; A an&#225;lise do subgrupo de linf&#243;citos mostrou uma redu&#231;&#227;o significativa no percentual de CD8 e um aumento significativo no percentual de CD19 no Grupo 2 em compara&#231;&#227;o com o Grupo 1&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">O n&#237;vel de albumina no sangue e o percentual de linf&#243;citos CD8 e CD19 &#40;&#43;&#41; no diagn&#243;stico podem ajudar a prever risco de doen&#231;a valvular cr&#244;nica em pacientes com cardite reum&#225;tica aguda&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Oner T&#44; Ozdemir R&#44; Genc DB&#44; Kucuk M&#44; Karadeniz C&#44; Demirpence S&#44; et al&#46; Parameters indicative of persistence of valvular pathology at initial diagnosis in acute rheumatic carditis&#58; the role of albumin and CD19 expression&#46; J Pediatr &#40;Rio J&#41;&#46; 2016&#59;92&#58;581&#8211;7&#46;</p>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">ASO&#44; antiestreptolisina O&#59; FE&#44; fra&#231;&#227;o de encurtamento&#59; TSE&#44; taxa de sedimenta&#231;&#227;o de eritr&#243;citos&#46;</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Caracter&#237;sticas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Idade &#40;a&#41;&#44; m&#233;dia</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DP &#40;faixa&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;23<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Sexo masculino</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;54&#44;5&#37; masculino&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Peso corporal &#40;kg&#41;&#44; m&#233;dia</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DP</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Presen&#231;a de crit&#233;rios importantes</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Artrite&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#47;22 &#40;81&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Coreia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;22 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Presen&#231;a de crit&#233;rios n&#227;o substanciais</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Febre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#47;22 &#40;45&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Artralgia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#47;22 &#40;13&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Intervalo PR prolongado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#47;22 &#40;18&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Provas de fase aguda elevadas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&#47;22 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Achados laboratoriais</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hemoglobina &#40;g&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;49<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Contagem de leuc&#243;citos &#40;&#47;mm<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;79<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Plaquetas &#40;mil&#47;mm<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">409<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>115&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>TSE &#40;&#47;h&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">106<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ASO &#40;IU&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1175<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>425&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Albumina &#40;g&#47;gL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Ecocardiografia</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>FE &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Eletrocardiograma</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Frequ&#234;ncia card&#237;aca &#40;pulso&#47;min&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">91&#44;10<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#44;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dispers&#227;o QTc &#40;ms&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Intervalo PR &#40;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;15<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">An&#225;lise do subgrupo de linf&#243;citos</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CD8 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#44;65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CD19 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#44;11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Vari&#225;vel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Grupo 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Grupo 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">N&#250;mero&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;77&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;22&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Faixa et&#225;ria &#40;m&#233;dia&#47;anos&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sedimenta&#231;&#227;o &#40;h&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">104&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>25&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">113&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>29&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ASO &#40;IU&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1192<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>438&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1118<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>418&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Leuc&#243;cito &#40;&#47;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;56<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hemoglobina &#40;g&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Plaquetas &#40;mil&#47;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">397<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">451<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>182&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Albumina &#40;g&#47;gL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fra&#231;&#227;o de encurtamento &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LVEDd &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;66<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ECG &#8211; Frequ&#234;ncia card&#237;aca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">86&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">111&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ECG &#8211; Dispers&#227;o QTc &#40;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;042<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;044<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ECG &#8211; Intervalo PR &#40;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;149<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;040&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;152<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;046&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1254114.png"
              ]
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        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Compara&#231;&#227;o do eletrocardiograma&#8208;ecocardiografia e achados laboratoriais dos grupos com e sem regress&#227;o na cardite</p>"
        ]
      ]
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        "identificador" => "tbl0015"
        "etiqueta" => "Tabela 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
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        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">In&#237;cio</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Seis meses depois</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Recupera&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Regurgita&#231;&#227;o mitral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Regurgita&#231;&#227;o a&#243;rtica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Regurgita&#231;&#227;o mitral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Regurgita&#231;&#227;o a&#243;rtica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Caso 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Caso 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Caso 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Caso 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Caso 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">moderada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Caso 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">moderada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">moderada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Caso 7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">moderada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Caso 8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">grave&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">moderada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">grave&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">moderada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Caso 9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Caso 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Caso 11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">moderada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Caso 12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">grave&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">grave&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Caso 13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">moderada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Caso 14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">moderada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Caso 15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">grave&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">moderada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Caso 16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Caso 17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">moderada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">moderada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Caso 18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">moderada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Caso 19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">grave&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">moderada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Caso 20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">grave&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">grave&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Caso 21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ausente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Caso 22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">grave&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">grave&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "pt" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Relato da gravidade do comprometimento valvular em todos os pacientes no in&#237;cio do estudo e no 6&#176; m&#234;s de acompanhamento</p>"
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CD4&#47;CD8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;62<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CD19 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#44;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "pt" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Compara&#231;&#227;o da an&#225;lise do subgrupo de linf&#243;citos dos grupos com &#40;Grupo 1&#41; e sem &#40;Grupo 2&#41; regress&#227;o da cardite</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Refer&#234;ncias"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:29 [
            0 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Serial studies on the cellular immune response to streptococcal antigens in acute and convalescent rheumatic fever patients in Trinidad"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;E&#46; Read"
                            1 => "H&#46;F&#46; Reid"
                            2 => "V&#46;A&#46; Fischetti"
                            3 => "T&#46; Poon-King"
                            4 => "R&#46; Ramkissoon"
                            5 => "M&#46; McDowell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Immunol"
                        "fecha" => "1986"
                        "volumen" => "6"
                        "paginaInicial" => "433"
                        "paginaFinal" => "441"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3536986"
                            "web" => "Medline"
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              "identificador" => "bib0155"
              "etiqueta" => "2"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Increase in activated T cells and reduction in suppressor&#47;cytotoxic T cells in acute rheumatic fever and active rheumatic heart disease&#58; a longitudinal study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "K&#46; Morris"
                            1 => "C&#46; Mohan"
                            2 => "P&#46;L&#46; Wahi"
                            3 => "I&#46;S&#46; Anand"
                            4 => "N&#46;K&#46; Ganguly"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8450263"
                            "web" => "Medline"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Selective depletion of Vbeta2&#43;CD8&#43;T cells in peripheral blood from rheumatic heart disease patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "F&#46; Carri&#243;n"
                            1 => "M&#46; Fernandez"
                            2 => "M&#46; Iruretagoyena"
                            3 => "L&#46;E&#46; Coelho Andrade"
                            4 => "M&#46; Odete-Hil&#225;rio"
                            5 => "F&#46; Figueroa"
                          ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Autoimmun"
                        "fecha" => "2003"
                        "volumen" => "20"
                        "paginaInicial" => "183"
                        "paginaFinal" => "190"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12657531"
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                    0 => array:2 [
                      "titulo" => "Recent progress in the understanding of B&#8208;cell functions in autoimmunity"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Porakishvili"
                            1 => "R&#46; Mageed"
                            2 => "C&#46; Jamin"
                            3 => "J&#46;O&#46; Pers"
                            4 => "N&#46; Kulikova"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
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                        "tituloSerie" => "Scand J Immunol"
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                      "titulo" => "B lymphocyte signaling pathways in systemic autoimmunity&#58; implications for pathogenesis and treatment"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Zouali"
                            1 => "G&#46; Sarmay"
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                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/art.20487"
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                        "tituloSerie" => "Arthritis Rheum"
                        "fecha" => "2004"
                        "volumen" => "50"
                        "paginaInicial" => "2730"
                        "paginaFinal" => "2741"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Expression and occupancy of BAFF&#8208;R on B cells in systemic lupus erythematosus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;H&#46; Carter"
                            1 => "H&#46; Zhao"
                            2 => "X&#46; Liu"
                            3 => "M&#46; Pelletier"
                            4 => "W&#46; Chatham"
                            5 => "R&#46; Kimberly"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/art.21489"
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                        "tituloSerie" => "Arthritis Rheum"
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                        "paginaFinal" => "3954"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16320342"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The CD19&#8208;CD21 complex regulates signal transduction thresholds governing humoral immunity and autoimmunity"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46;F&#46; Tedder"
                            1 => "M&#46; Inaoki"
                            2 => "S&#46; Sato"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Immunity"
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