scholarly journals Epidemiological and sociodemographic characterization of women and men with cancer in a State in the Brazilian Amazon

Author(s):  
Carlos Alberto Paraguassu Chaves ◽  
Allan Kardec Duailibe Barros Filho ◽  
Carlos de Andrade Macieira ◽  
Fabrício Moraes de Almeida ◽  
Lenita Rodrigues Moreira Dantas ◽  
...  

Objective: Objective: Analyzes the epidemiological and sociodemographic characterization of women and men with cancer in the State of Rondônia, Western Amazon (Brazil), diagnosed over a period of 2 (two) years. Materials and Methods: It is a documentary, cross-sectional and descriptive study, with the systematization of primary data, according to the methodological model recommended by Paraguassú-Chaves et al [25]. We used an instrument developde by Paraguassu-Chaves et al [26], semi-structured, divided into two blocks: (a) Block I – sociodemographic profile and (b) Block II – epidemiological profile. The Ethics Committee on Human Research at the reference hospital was asked to waive the Informed Consent Form. The research project is in accordance with Resolution 196/96 of the National Health Council of Brazil. Results: Of the 3.333 new cases of cancer, 53.4% ​​were female and 46.5% male. The 10 (ten) most common types of cancer among men and women in Rondônia over a 2-year period were non-melanoma skin (C44), breast (C50), prostate (C61), cervix (C53), stomach (C16), thyroid gland (C73), bronchi and lungs (C33-C34), colon (C18), reticuloendothelial hematopoietic system (C42) and rectal cancer (C20). An age range of 50 to 69 years was predominant in both sexes and patients with low educational level. The highest frequency was for married patients. There was a predominance of brown skin, patients born in the State of Rondônia (22.6%) and agricultural workers. The Unified Health System - SUS was responsible for the entry for treatment of 99.5% of patients. Most patients underwent “other isolated therapeutic procedures” and with the disease in advanced stages. Conclusions: The estimate of new cancer cases in Rondônia follows an increasing trend. The scenarios selected from the variables of the sociodemographic and epidemiological indicators of the research require the public health authorities of Rondônia, urgent redirection of actions and strategies for the prevention, control, assistance and treatment of cancer in women and men in Rondônia.

Author(s):  
Carlos Alberto Paraguassu-Chaves ◽  
Allan Kardec Duailibe Barros Filho ◽  
Fabrício Moraes de Almeida ◽  
Lenita Rodrigues Moreira Dantas ◽  
João Viana Fonseca Neto ◽  
...  

Objective: to analyze the epidemiological, sociodemographic and clinical profile of men in Rondônia, Western Amazonia (Brazil), diagnosed with the main types of cancer, during a period of 2 (two) years. Materials and Methods: it is an epidemiological, descriptive, cross-sectional and quantitative study, with the systematization of primary data according to the methodological model recommended by Paraguassu-Chaves et al [6]. We used an instrument developed by Paraguassu-Chaves et al [5], semi-structured composed of a series of epidemiological, clinical and sociodemographic variables. The research project is in compliance with Resolution 196/96 of the National Health Council of Brazil, taking into account the ethical aspects of research in Brazil. Main results: the 10 (ten) main types of cancer diagnosed by the location of the primary tumor in men were analyzed, corresponding to 1,163 (74.9%) cases of cancer in men, over a period of 2 (two) years. The 10 (ten) most common types of cancer in men were: prostate (30.9%), non-melanoma skin (22.9%), stomach (11.7%), bronchi and lungs (6.7%), colon (5.8%), leukemia (5.8%), esophagus (4.4%), central nervous system (4.2%), rectum (3.9%) and bladder (3.6%). The age group of 50 to 79 years old reaches 76.4% of the 10 main types of cancer in men. They are more frequent in brown (64.6%) and white (28%) men and with low education. 73.2% of men with cancer are married. 44.9% of men with cancer work in agriculture. 45.6% of men with cancer have a family history of cancer. The sum of smokers and ex-smokers reaches a relative frequency of 43.7%. 19.5% consume alcoholic beverages and 17.2% are ex-consumers. In 40.1%, "other isolated therapeutic procedures" were applied in the first treatment. 14.2% of diagnosed patients died from the disease. Conclusions: The scenario of cancer projection in men in Rondônia is worrying and requires an urgent redirection of actions and strategies for cancer prevention, control, assistance and treatment.


2020 ◽  
Vol 7 (3) ◽  
pp. 84-87
Author(s):  
Euber Joe Jurado Martinez

RESUMO Objetivo: Este estudo tem como objetivo traçar o perfil epidemiológico dos óbitos por câncer de estômago no estado do Tocantins de 2010 a 2018. Métodos: Estudo epidemiológico de natureza quantitativa, descritiva e transversal. Os dados foram coletados no Sistema de Informações sobre Mortalidade (SIM) disponível no DATASUS (Departamento de Informática do Sistema Único de Saúde do Brasil). As variáveis coletadas foram o número total de óbitos, bem como, o sexo, faixa etária e a cor/raça dos indivíduos. Resultados: O número total de óbitos no estado do Tocantins no período em questão foi de 549, sendo o ano de 2017 o que mais apresentou casos, com 87 óbitos. Se levarmos em consideração o sexo das vítimas, podemos observar que houve um predomínio de indivíduos do sexo masculino com 357 óbitos, representando 67% do total de óbitos. No que diz respeito a faixa etária, verificamos uma grande quantidade de casos em pessoas acima de 60 anos, com 362 óbitos (66%), seguidos pela faixa etária de 40 a 59 anos com 157 óbitos (28,5%), 20 a 39 anos com 29 óbitos (5,3%) e abaixo de 20 anos com 1 óbito (0,2%). A média de idade calculada foi de 65,76 anos. Em relação a cor/raça notamos que os pardos lideram as estatísticas com 335 óbitos, correspondendo a 61% do total de óbitos. Conclusão: Levando em consideração o panorama mostrado, nota-se que o perfil epidemiológico dos óbitos por câncer de estômago no Tocantins entre 2010 e 2018 é composto por homens, acima de 60 anos, da raça parda. A erradicação do Helicobacter pylori representa um alvo para a prevenção primária do câncer gástrico. Portanto, representa um importante problema de saúde pública que requer atenção dos gestores públicos para a elaboração de medidas públicas, visando o planejamento dos recursos para a proteção da população tocantinense. Palavras-chave: Neoplasias Gástricas; Perfil de Saúde; Mortalidade.   ABSTRACT Objective: This study aims to trace the epidemiological profile of deaths from stomach cancer in the state of Tocantins from 2010 to 2018. Methods: Epidemiological study of quantitative, descriptive and cross-sectional nature. Data were collected in the Mortality Information System (SIM) available at DATASUS (Department of Informatics of the Brazilian Unified Health System). The variables collected were the total number of deaths, as well as the sex, age group and color/race of the individuals. Results: The total number of deaths in the state of Tocantins in the period in question was 549, with 2017 having the highest number of cases with 87 deaths. If we take into account the sex of the victims, we can see that there was a predominance of male individuals with 357 deaths, representing 67% of the total deaths. Regarding the age group, we verified a large number of cases in people over 60 years old, with 362 deaths (66%), followed by the age group from 40 to 59 years old with 157 deaths (28.5%), 20 to 39 years old with 29 deaths (5.3%) and under 20 years old with 1 death (0.2%). The average age calculated was 65.76 years. Regarding color/race, we noticed that browns lead the statistics with 335 deaths, corresponding to 61% of the total deaths. Conclusion: Taking into account the panorama shown, it is noted that the epidemiological profile of deaths from stomach cancer in Tocantins between 2010 and 2018 is composed of men, over 60 years old, of the brown race. The eradication of Helicobacter pylori represents a target for the primary prevention of gastric cancer. Therefore, it represents an important public health problem that requires the attention of public managers for the elaboration of public measures, aiming at the planning of resources for the protection of the Tocantins population. Keywords: Stomach Neoplasms; Epidemiology; Mortality.


2011 ◽  
Vol 5 (6) ◽  
pp. 1475
Author(s):  
Marco Aurélio Soares Amorim ◽  
Denismar Borges Miranda ◽  
Renata Campos Simões Cabral ◽  
Ana Verônica Mascarenhas Batista

ABSTRACTObjective: to describe the clinical and epidemiological profile of patients with HIV/AIDS hospitalized at the Hospital for Reference in the state of Bahia, Brazil. Method: a descriptive retrospective cross-sectional study. The sample comprised of patients admitted to the hospital for the treatment of HIV/AIDS in Salvador, Bahia, Brazil, from January to December 2008; the data was obtained from medical records upon approval by the Committee for Ethics in Research of Hospital Couto Maia (protocol 15/2009). Results: for the 194 patients studied, the average age was 37.8 years, ± 10.7 years. The predominant age group was 21 to 50 years old, which represented 87.5% of the all patients. Prior to hospitalization, about 150 patients were already diagnosed with HIV/AIDS and 54 were in regular use of antiretroviral therapy. Diarrhea, toxoplasmosis and esophageal candidiasis were the most common opportunistic diseases encountered. The average CD4 was 82 cells/mm3, ranging from 7 to 1,099. Of the 194 patients studied, 65 (33.5%) died and the highest mortality rates were attributed to Kaposi's sarcoma (75.0%) and toxoplasmosis (42.2%). Conclusions: the clinical and epidemiological profile of the patients with HIV/AIDS analyzed consists of young heterosexuals adult males, who were diagnosed previously to their hospitalization and whose main reason for hospitalization was related to opportunistic diseases. Descriptors: acquired immunodeficiency syndrome; health profile; aids-related opportunistic infections.RESUMOObjetivo: descrever o perfil clínico-epidemiológico dos pacientes internados com HIV/AIDS no Hospital de Referência do Estado da Bahia. Método: estudo descritivo retrospectivo, de corte transversal. A amostra foi composta pelos pacientes internados no hospital de referência no tratamento de HIV/AIDS da cidade de Salvador-Ba, entre janeiro a dezembro de 2008; os dados foram obtidos de prontuários médicos após aprovação do Comitê de Ética em Pesquisa do Hospital Couto Maia com protocolo 15/2009. Resultados: dos 194 pacientes, observou-se média de idade de 37,8 anos ± 10,7 anos. Predominou faixa etária entre 21 e 50 anos somando 87,5% dos pacientes. Cerca de 150 pacientes tinham diagnóstico prévio à internação e 54 estavam em uso regular de TARV na admissão. Diarréia, neurotoxoplasmose e candidíase esofágica foram as doenças oportunistas mais freqüentes. A mediana de CD4 foi de 82 variando de 7-1.099 células/mm3. Observou-se que, 65 (33,5%) foram a óbito e as maiores taxas de letalidade foram atribuídas ao Sarcoma de Kaposi (75,0%) e neurotoxoplasmose (42,2%). Conclusão: o perfil clínico-epidemiológico dos pacientes com HIV/AIDS internados em estudo é composto por adultos jovens, do gênero masculino, heterossexuais que possuíam diagnóstico prévio a internação, cujo principal motivo de internação esteve relacionado à doença oportunista. Descritores: síndrome de imunodeficiência adquirida; perfil de saúde; infecções oportunistas relacionadas com a aids.RESUMENObjetivo: describir las características clínicas y epidemiológicas de los pacientes con VIH/SIDA en el hospital de referencia del estado de Bahía, Brasil. Método: estudio retrospectivo observacional descriptivo de corte transversal. La muestra se compone de los pacientes ingresados en el hospital para el tratamiento del VIH/SIDA, en Salvador, Bahía, Brasil, entre enero y diciembre de 2008; los datos se obtuvieron a partir de los registros médicos seguidamente a la aprobación por el Comité de Ética en Investigación del Hospital Couto Maia (protocolo 15/2009). Resultados: de los 194 pacientes estudiados la edad promedio fue de 37,8 años ± 10,7 años. El grupo de edad predominante fue de 21 a 50 años, lo que representa 87,5% del total de pacientes. Alrededor de 150 pacientes fueron diagnosticados antes de la admisión y 54 hacían uso regular de la terapia antirretroviral cuando del ingreso. Se observó que la diarrea, toxoplasmosis y candidiasis esofágica fueron las enfermedades oportunistas más frecuentes. El promedio de CD4 fue de 82 células/mm3, entre 7 y 1.099. De los 194 pacientes estudiados, 65 (33,5%) fallecieron y las tasas de mortalidad más altas se atribuyen al sarcoma de Kaposi (75,0%) y toxoplasmosis (42,2%). Conclusiones: el perfil clínico y epidemiológico de los pacientes con VIH/SIDA analizados se compone de jóvenes adultos, hombres, heterosexuales, que habían sido diagnosticados previamente a la hospitalización y cuyo principal motivo para el ingreso en el hospital estaba relacionado con enfermedades oportunistas. Descriptores: síndrome de inmunodeficiencia adquirida; perfil de salud; infecciones oportunistas relacionadas con la sida.


2012 ◽  
Vol 69 (8) ◽  
pp. 1480-1490 ◽  
Author(s):  
Eva A. Papaioannou ◽  
Athanasios T. Vafeidis ◽  
Martin F. Quaas ◽  
Jörn O. Schmidt

Abstract Papaioannou, E. A., Vafeidis, A. T., Quaas, M. F., and Schmidt, J. O. 2012. The development and use of a spatial database for the determination and characterization of the state of the German Baltic small-scale fishery sector. – ICES Journal of Marine Science, 69: . Although substantial progress has been made in the acquisition and analysis of fishery data, the small-scale fishery (SSF) sector is frequently data deficient, with relevant primary data often being fragmented and incomplete. Also, in contrast to the case of the larger scale sector, a coherent methodological framework for the assessment of the SSF has, in most cases, not been formulated. In the present study, the methodology of developing a database for the German Baltic SSF sector is presented. The aim of the database is to combine fishery primary data effectively and enable the sound determination and characterization of the German Baltic SSF sector. Data used include, among others, fleet data derived from the European Community Fleet Register (CFR) database and logbook data from the German Federal Office for Agriculture and Food (BLE). The database includes information on the technical specifications of SSF vessels (length, engine power, etc.); the sector's operational range; main target species; fishing grounds; landing ports; and weight and price of landings. Results of employing the database for profiling the state of the SSF sector (in 2008) are presented. The results demonstrate the benefits of such an approach within the framework of managing coastal fish resources and fishing activities.


2019 ◽  
Vol 14 ◽  
pp. 3146-3160
Author(s):  
Taofik Olatunji Bankole ◽  
Daniel Denny Gray ◽  
Abiodun Oluwaseun Oyebode ◽  
Gbelimu Elizabeth Lawal

Every country institutes policy to take a course of action in favour of its citizens’ welfare. The view of indigenization policy in alignment with employment and workers treatment in Liberia takes different dimension. Liberia problem of unemployment cannot be compared to its underemployment and bad working conditions. The Liberian Indigenous policy has not reaped its fruit with marginalization, exploitation dispossession and poverty in commonplace. This study addresses the ineffectiveness of the indigenous employment policy and the state of workers’ well-being in foreign corporations in Liberia. This study adopts cross sectional method, and employs primary data. Information from 400 employees working with foreign-owned corporation was extracted from survey conducted in 2018 by the authors on the state of welfare of foreign-owned corporations’ employees in Liberia. The key explanatory variables are healthcare, social insurance, safety measures, stable job assignment, stable work hour, promotion on the job, and job security. The binary logistic regression was applied using version 22 of SPSS to examine association between the response and explanatory variables. The outcomes of this study showed that indigenous environmental policy was significant with worker’s well-being (p<0.05). The study concluded that indigenous employment policy has significant influence on the foreign-owned corporation workers’ well-being in Liberia.


2020 ◽  
Vol 13 (11) ◽  
pp. 89
Author(s):  
M. H. S. Lemos ◽  
M. A. O. Costa ◽  
L. P. Lages ◽  
T. C. Soares ◽  
D. A. M. Araújo ◽  
...  

Neglected diseases are characterized as a group of diseases that contribute to the maintenance of inequality. This study aimed to characterize the epidemiological profile of neglected diseases in the state of Piauí. This was an ecological, exploratory, retrospective, descriptive and quantitative study with data obtained from the Information System for Notifiable Diseases of the Piauí State Department of Health of neglected diseases in the state: Leprosy, Tuberculosis, Visceral Leishmaniasis, Leishmaniasis American cutaneous, Chagas disease and Geohelminthiases. The selection of data took place between 2012 and 2016, except for Geohelminthiases, which followed the Ministry of Health campaign that took place between 2014 and 2016. The organization and data analysis took place using the software Tabwin 4.1.4 and Microsoft Excel. 5251 leprosy cases with a predominance of multibacillary cases (60.22%) were reported. Regarding Tuberculosis, there were 3369 cases with a predominance between 20 and 49 years old (50.73%). Regarding Leishmaniasis, 1052 cases were reported with a predominance of Visceral Leishmaniasis (84.3%) while Chagas' disease, 90 cases were reported. Regarding Geohelminthiasis, 1029 schools and 155,082 students joined the campaign, 77.69% of whom were treated with albendazole. In Piauí, case records of neglected diseases are high, with the need to intensify control actions, which can contribute to an efficient performance of surveillance of these diseases and improvement of the population's quality of life.


Author(s):  
◽  

Objective: To analyze the epidemiological profile of congenital syphilis in the state of Alagoas from 2015 to 2019. Methods: Epidemiological study characterized as descriptive, observational, retrospective and cross-sectional, carried out based on data collected from the Information System for Notifiable Diseases (SINAN) and made available by the Department of Chronic Conditions and Sexually Transmitted Infections. Results and Discussions: When observing the cases of congenital syphilis, 2019 saw a significant drop in cases compared to the years 2015 to 2018. Conclusion: It is concluded that the epidemiological profile of DES demonstrates that the number of cases is higher among children under 7 days of age, the mother’s age range between 20 and 29 years, the mother’s education level from 5th to 8th grade incomplete and race / color of the mother, brown. This reflects for health professionals to seek more strategies to eradicate the disease in the state and in Brazil.


2021 ◽  
Author(s):  
Isaac Rêgo Purificação ◽  
Allêh Kauãn Santos Nogueira ◽  
Matheus Araújo de Souza ◽  
João Vitor Lopes Lima ◽  
Douglas Mateus Pereira Jorge ◽  
...  

Background: The incidence of Cerebrovascular Diseases (CVD) increases significantly with age, being more frequent in the elderly. For this reason, there are still few studies that describe the epidemiological profile of these pathologies in youn g adults. Methods and Objective: From the data collected prospectively and allocated on the TabNet platform (DataSUS, MS), an observational, descriptive and cross-sectional study was carried out. As a primary objective, we seek to describe the demographic information most associated with CVD mortality in individuals between 20 and 49 years old, in São Paulo. Results: The year 2011 emerged in relation to mortality, with 1,432 deaths; in the 2010- 2019 period, the average number of deaths (± standard deviation [SD]) was 1,318 (± 61), per year. In this period, the number of deaths was higher in the capital (4,605; 34.9% of the total in the state). The mean deaths (± SD), per year, in the capital and in the interior cities were, respectively: 442 (± 58) and 2.4 (± 6.2). People with schooling from 4 to 7 years old and from 8 to 11 years old were the most affected. The ratio of male deaths to female deaths was 1.05. Conclusion: There is relative stability in relation to mortality per year among young adults in the state of SP, the capital being the city with the highest number of deaths. Male individuals, with a medium level of education were responsible for most of the deaths.


Author(s):  
Carolina Gomes Almeida ◽  
Gabriel Pereira Ávila ◽  
Isabelly Montenegro Teixeira ◽  
Raíza Júlia Viana Rodrigues ◽  
Claudio Alberto Gellis de Mattos Dias ◽  
...  

Syphilis is a disease caused by the bacterium Treponema pallidum, acquired, in large part, by sexual transmission. Congenital syphilis is a contagious disease of vertical transmission (from mother to fetus). This study aimed to present the number of reported cases of congenital syphilis in northern Brazil, between 2014 and 2019, and to characterize the epidemiological profile of the cases. Descriptive, cross-sectional and retrospective research was carried out using DATASUS database. There was an increase in the number of cases in the period evaluated, especially the State of Amazonas, which presented the highest number of notifications. Regarding prenatal care, an average of four times more women perform than those who did not. Women with maternal school grade from the 5th to 8th incomplete elementary school had a higher number of cases of the disease. Although the northern region had a high prenatal performance, most cases of congenital syphilis were diagnosed only after delivery, indicating erroneous interpretations regarding the tests and consequent error in diagnosis and treatment. Since the early form (emergence until the 2nd year of life) is the majority of the number of cases, there is a favorable evolution of the disease.Schooling and income seem to be factors that influence the late diagnosis of the disease. There is a need for increased treated partners, reducing the transmission of syphilis and, consequently, congenital syphilis.


2018 ◽  
Vol 12 (2) ◽  
pp. 379
Author(s):  
Júlia Trevisan Martins ◽  
Maria José Quina Galdino ◽  
Alessandro Rolim Scholze ◽  
Júlia Jetarchuki Ribas ◽  
Luma Nascimento Silva ◽  
...  

RESUMOObjetivo: identificar o perfil epidemiológico, evolução clínica e desfecho de pacientes atendidos com diagnóstico de Síndrome Coronariana Aguda em um pronto-socorro. Método: estudo quantitativo, transversal e exploratório, no qual foram analisados 367 prontuários. Os dados foram registrados em formulário estruturado para identificar os dados sociodemográficos e analisados por meio do Programa SPSS - versão 16.0, em que se utilizou estatística descritiva por média e frequências relativas e absolutas. Resultados: a idade média foi de 62,1 anos e predominaram o sexo masculino, a raça branca e casados. A prevalência de infarto agudo do miocárdio foi de 84,5%, diagnosticado por eletrocardiograma, ecocardiograma e enzimas cardíacas seriadas. Os tratamentos mais realizados foram os medicamentos antiagregantes plaquetários (64,3%), cateterismo cardíaco (65,4%) e a intervenção coronariana percutânea (27,2%). A maioria teve alta hospitalar, porém a taxa de mortalidade foi de 13,2%. Conclusão: os resultados demonstraram a importância da caracterização desses atendimentos, visto que pode colaborar para o planejamento de políticas públicas e ações intervencionistas que visem à prevenção das doenças cardíacas, redução das comorbidades e início de tratamento precoce. Descritores: Doença das Coronárias; Síndrome Coronariana Aguda; Serviços Médicos de Emergência; Infarto do Miocárdio.ABSTRACTObjective: to identify the epidemiological profile, clinical evolution and outcome of patients treated with a diagnosis of Acute Coronary Syndrome in an emergency room. Method: a quantitative, cross-sectional and exploratory study, in which 367 medical records were analyzed. The data were recorded in a structured form to identify the sociodemographic data and analyzed through the SPSS Program - version 16.0, in which descriptive statistics were used by means of relative and absolute frequencies. Results: the mean age was 62.1 years and male, white and married participants were predominant. The prevalence of acute myocardial infarction was 84.5%, diagnosed by electrocardiogram, echocardiogram and serial cardiac enzymes. The most commonly performed treatments were antiplatelet drugs (64.3%), cardiac catheterization (65.4%) and percutaneous coronary intervention (27.2%). Most were discharged from hospital, but the mortality rate was 13.2%. Conclusion: the results showed the importance of the characterization of this type of care, since it can help in the planning of public policies and interventionist actions aimed at the prevention of heart disease, reduction of comorbidities and early treatment. Descriptors: Coronary Disease; Acute Coronary Syndrome; Emergency Medical Services; Myocardial Infarction.RESUMENObjetivo: identificar el perfíl epidemiológico, evolución clínica y desarrollo de pacientes atendidos con diagnóstico de Síndrome Coronario Agudo en un pronto-socorro. Método: estúdio cuantitativo, transversal y exploratorio, en el cual fueron analizados 367 prontuarios. Los datos fueron registrados en formulario estructurado para identificar los datos sociodemográficos y analizados por medio del Programa SPSS - versión 16.0, en que se utilizó estadística descriptiva por media y frecuencias relativas y absolutas. Resultados: la edad media fue de 62,1 años y predominaron el sexo masculino, la raza blanca y los casados. La prevalencia de infarto agudo del miocárdio fue de 84,5%, diagnosticado por eletrocardiograma, ecocardiograma y enzimas cardíacas seriadas. Los tratamientos más realizados fueron los medicamentos antiagregantes plaquetários (64,3%), cateterismo cardíaco (65,4%) y la intervención coronaria percutánea (27,2%). La mayoría tuvo alta hospitalario, sin embargo la taza de mortalidad fue de 13,2%. Conclusión: los resultados demostraron la importancia de la caracterización de esos atendimientos, ya que puede colaborar para el planeamiento de políticas públicas y acciones intervencionistas que busquen la prevención de las enfermedades cardíacas, reducción de las comorbidades e início de tratamiento precoz. Descriptores: Enfermedad Coronaria; Síndrome Coronario Agudo; Servicios Médicos de Urgencia; Infarto do Miocárdio.


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