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Oliveira MS, Torquato BGS, Soares MH, Monteiro MLGDR, Juliano GR, Aguiar LS, Teixeira VDPA, Ferraz MLDF. Macroscopic Evaluation of Atherosclerosis in the Arteries: An Autopsy Assessment Tool. Arq Bras Cardiol 2021; 116:1119-1126. [PMID: 34133598 PMCID: PMC8288540 DOI: 10.36660/abc.20190846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 05/20/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Atherosclerosis, in some cases, is an asymptomatic condition, and it is important to know the degree of arterial impairment caused by plaques and its association with risk factors. Autopsy examination provides understanding of basic disease processes and assessment to data about macroscopic characteristic of atherosclerotic involvement. OBJECTIVE To macroscopically assess and standardize atherosclerotic involvement of aorta, carotid and iliac arteries and compare with age, gender and causes of death. METHODS We collected 53 aortic arteries, 53 right carotid arteries, 53 left carotid arteries, 53 right iliac arteries and 53 left iliac arteries. For this assessment, the extension of fatty streaks, atheromatous plaques, fibrosis and calcification were considered, being the reference to score the degree of atherosclerotic involvement. Many degrees of atherosclerosis and accurate values were observed for mild, moderate and severe classification. For statistical analysis, data were analyzed using the software GraphPad Prism® 7.0. Differences were considered statistically significant if p-value was less than 5% (p <0.05). RESULTS Carotid arteries had greater atherosclerotic involvement compared to the other arteries (K = 15.73, p = 0.0004). Atherosclerosis was progressive and significant with increasing age (carotid arteries: t = 6.321; p <0.0001; aorta: U = 83.5; p <0.0001; iliac: U = 306; p <0.0001) and as cause of cardiovascular death (carotids: t = 5.047; p <0.0001; aorta: U = 98.5; p = 0.0068; iliac: U = 467.5; p = 0.0012). CONCLUSION Macroscopic assessment of atherosclerosis is an innovative and low-cost way of direct visualization of atherosclerotic plaques, enabling an association with risk factors such as increasing age and cardiovascular diseases, providing important data for clinical practice.
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Oliveira MS, da Silva Torquato BG, Tsuji SY, Aguiar LS, Juliano GR, da Silveira LAM, Miranda Corrêa RR, Rocha LB, da Fonseca Ferraz ML. Morphological and Histopathological Study of Autopsied Patients with Atherosclerosis and HIV. Curr HIV Res 2021; 19:121-127. [PMID: 33135614 DOI: 10.2174/1570162x18999201029123356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/18/2020] [Accepted: 10/02/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Chronic infection by HIV evolves with a vascular inflammatory action causing endothelial dysfunction. The action of the virus, as well as the side effects of antiretroviral drugs, contribute to the progression of cardiovascular diseases. The present study aimed to evaluate the percentage of collagen fibers and the density of mast cells, chymase and tryptase, in aortas of patients with and without HIV, and also patients with and without atherosclerosis. METHODS Aortic fragments were obtained from autopsied patients aged 22-69 years and selected regardless of the cause of death or underlying disease. The samples were divided into four groups, (1) Group with HIV and with atherosclerosis; (2) Group with HIV and without atherosclerosis; (3) Group without HIV and with atherosclerosis; (4) Group without HIV and without atherosclerosis (Control). The percentage of collagen fibers was analyzed in the intima-media layer and the density of mast cells was analyzed in all aortic layers. Graphpad Prism 5.0® software was used for statistical analysis. RESULTS There were more collagen fibers in HIV patients, with or without atherosclerosis. The group with HIV and atherosclerosis presented a higher density of chymase and tryptase mast cells. The correlation between collagen fibers and age was negative in the non-HIV group and with atherosclerosis. CONCLUSION The inflammatory process resulting from HIV infection may be relevant in the alteration of aortic collagen fibers and in triggering or accelerating atherosclerosis. The study is important because HIV patients have increased risks for the development of cardiovascular diseases, and follow-up is necessary to prevent such diseases.
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Affiliation(s)
- Mariana Silva Oliveira
- General Pathology Department, Triângulo Mineiro Federal University, St: Frei Paulino, 30. Zip Code: 38025-180, Uberaba, Minas Gerais, Brazil
| | - Bianca Gonçalves da Silva Torquato
- General Pathology Department, Triângulo Mineiro Federal University, St: Frei Paulino, 30. Zip Code: 38025-180, Uberaba, Minas Gerais, Brazil
| | - Simone Yumi Tsuji
- General Pathology Department, Triângulo Mineiro Federal University, St: Frei Paulino, 30. Zip Code: 38025-180, Uberaba, Minas Gerais, Brazil
| | - Laura Sanches Aguiar
- General Pathology Department, Triângulo Mineiro Federal University, St: Frei Paulino, 30. Zip Code: 38025-180, Uberaba, Minas Gerais, Brazil
| | - Guilherme Ribeiro Juliano
- General Pathology Department, Triângulo Mineiro Federal University, St: Frei Paulino, 30. Zip Code: 38025-180, Uberaba, Minas Gerais, Brazil
| | - Luciano Alves Matias da Silveira
- General Pathology Department, Triângulo Mineiro Federal University, St: Frei Paulino, 30. Zip Code: 38025-180, Uberaba, Minas Gerais, Brazil
| | - Rosana Rosa Miranda Corrêa
- General Pathology Department, Triângulo Mineiro Federal University, St: Frei Paulino, 30. Zip Code: 38025-180, Uberaba, Minas Gerais, Brazil
| | - Lenaldo Branco Rocha
- General Pathology Department, Triângulo Mineiro Federal University, St: Frei Paulino, 30. Zip Code: 38025-180, Uberaba, Minas Gerais, Brazil
| | - Mara Lúcia da Fonseca Ferraz
- General Pathology Department, Triângulo Mineiro Federal University, St: Frei Paulino, 30. Zip Code: 38025-180, Uberaba, Minas Gerais, Brazil
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Altered Vascular Extracellular Matrix in the Pathogenesis of Atherosclerosis. J Cardiovasc Transl Res 2021; 14:647-660. [PMID: 33420681 DOI: 10.1007/s12265-020-10091-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/01/2020] [Indexed: 12/18/2022]
Abstract
Cardiovascular disease continues to grow as a massive global health burden, with coronary artery disease being one of its most lethal varieties. The pathogenesis of atherosclerosis induces changes in the blood vessel and its extracellular matrix (ECM) in each vascular layer. The alteration of the ECM homeostasis has significant modulatory effects on the inflammatory response, the proliferation and migration of vascular smooth muscle cells, neointimal formation, and vascular fibrosis seen in atherosclerosis. In this literature review, the role of the ECM, the multitude of components, and alterations to these components in the pathogenesis of atherosclerosis are discussed with a focus on versatile cellular phenotypes in the structure of blood vessel. An understanding of the various effects of ECM alterations opens up a plethora of therapeutic options that would mitigate the substantial health toll of atherosclerosis on the global population.
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Morphological and histopathological evaluation of autopsied patients with hypertensive cardiopathy. Ann Diagn Pathol 2019; 41:79-82. [PMID: 31146181 DOI: 10.1016/j.anndiagpath.2019.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 04/22/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Physiopathological processes in hypertensive heart disease are controlled by complex interactions between cardiomyocytes, extracellular matrix, microvasculature and other cells present in the myocardium. OBJECTIVE To analyze morphological changes in hypertensive cardiopathy and to describe and compare findings in order to help clarify determinant factors. METHODS 42 fragments of the left ventricular myocardium and circumflex branch of the left coronary artery were obtained from individuals autopsied at the Clinical Hospital of the Federal University of Triângulo Mineiro (UFTM) in the period ranging from 1984 to 2018. Groups were split into individuals with hypertensive heart disease (HD) and individuals without heart disease (ND). Wall thickness was measured with a digital caliper and Computed Tomography. Quantification of collagen fibers was conducted by computerized morphometry and mast cell density was assessed by immunohistochemical methods. RESULTS There was a significant increase of heart weight in the HD group compared to the ND group, (p = 0.0002). There was a significant increase of thickness of the middle third of the free wall in the HD group compared to the ND group, (p = 0.04). There was a significant increase of collagen fibers in the left ventricle in the HD group compared to the ND group, (p < 0.0001). Concerning mast cell density, there was a significant increase in the left ventricle of individuals with HD immuno-labeled by the set anti-chymase/anti-tryptase (p < 0.0001). There was a significant increase of mast cell density in the circumflex branch of the left coronary artery of individuals with HD immuno-labeled by the set anti-chymase/anti-tryptase (p = 0.01). CONCLUSIONS Mast cells are involved in the development of hypertensive heart disease, contributing to the remodeling of collagen fibers in this disease.
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Oliveira MS, Torquato BGS, da Silveira LAM, Juliano GR, Aguiar LS, Juliano GR, Oliveira LF, Espindula AP, Ramalho LS, Cavellani CL, da Silva ACS, de Aquino Favarato GKN, de Paula Antunes Teixeira V, da Fonseca Ferraz ML. Evaluation of aortic changes in elderly people autopsied with acquired immunodeficiency syndrome. SURGICAL AND EXPERIMENTAL PATHOLOGY 2018. [DOI: 10.1186/s42047-018-0025-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To verify the distribution of the degree of fat deposits and percentage of collagen and elastic fibers in the intimal and medial layers of the aorta of elderly patients autopsied, with and without Acquired Immunodeficiency Syndrome (AIDS).
Methods
Twenty-six fragments of the aorta from elderly patients autopsied in the period from 1982 to 2014, were collected and, divided into two groups, being 13 with AIDS and 13 without AIDS. The intensity of the atherosclerosis was macroscopically evaluated in a semi-quantitative way. To quantify the elastic and collagen fibers, it was used the Leica Qwin Plus® software.
Results
In the comparison of the macroscopic intensity of atherosclerosis, the AIDS group (t = 0.6969, p = 0.4992). Regarding elastic fibers, there was a significant increase in the AIDS group (U = 115,800; p < 0.0001). Comparing the groups, there was a significant increase of the collagen fibers in the aortic layers in the AIDS group (U = 114,100; p < 0.0001).
Conclusion
The infection by the HIV influence in the amount of fibers in the extracellular matrix and the intensity of lipid deposit, demonstrating that it may be a risk factor to be considered for the development of atherosclerosis.
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Soares MH, Oliveira MS, da Silva ACS, Torquato BGS, Juliano GR, Juliano GR, de Araújo MF, Cavellani CL, Oliveira LF, Ferraz MLF, de Paula Antunes Teixeira V. Study of atherosclerosis in abdominal aortic aneurysms of autopsied patients. Artery Res 2018. [DOI: 10.1016/j.artres.2018.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Acele A, Baykan AO, Yüksel Kalkan G, Çeliker E, Gür M. Epicardial fat thickness is associated with aortic intima-media thickness in patients without clinical manifestation of atherosclerotic cardiovascular disease. Echocardiography 2017; 34:1146-1151. [PMID: 28670756 DOI: 10.1111/echo.13600] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Although the relationship between epicardial fat thickness (EFTh) and coronary atherosclerosis is well established, this relation in the early periods of atherosclerosis has not been fully demonstrated. On the other hand, thoracic aortic intima-media thickness (IMT) rather than carotid IMT was reported as an earlier marker of preclinical atherosclerosis. OBJECTIVE We aimed to assess the relationship between thoracic aortic IMT and EFTh in patients undergoing transesophageal echocardiography (TEE) examination for different indications. METHODS We included 104 patients (mean age 38±11.4 years), who underwent TEE for various indications. The patients were divided into two groups according to the median thoracic aortic IMT values (IMT normal group<10 mm and IMT abnormal group≥10 mm). EFTh was obtained using two-dimensional transthoracic echocardiography on the right ventricular free wall during systole and diastole. RESULTS The highest EFTh values (3.3±0.96 mm vs. 4.51±0.66 mm, P<.001) were observed in the abnormal aortic IMT group. Multivariate linear regression analysis showed that aortic IMT was independently correlate with EFTh (β=0.423, P<.001). Moreover, EFTh was found to be associated with history of transient ischemic attack (r=.403, P<.001) and abnormal IMT (r=.643, P<.001) in bivariate analysis. CONCLUSION Epicardial fat thickness is independently related to the extent of subclinical thoracic aortic atherosclerosis. Increase in EFTh may be crucial marker for initial atherosclerosis.
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Affiliation(s)
- Armağan Acele
- Department of Cardiology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Ahmet O Baykan
- Department of Cardiology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Gülhan Yüksel Kalkan
- Department of Cardiology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Emel Çeliker
- Department of Cardiology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Mustafa Gür
- Department of Cardiology, Adana Numune Training and Research Hospital, Adana, Turkey
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Silveira LAMD, Torquato BGS, Oliveira MS, Juliano GR, Oliveira LF, Cavellani CL, Ramalho LS, Espindula AP, Teixeira VDPA, Ferraz MLF. Implications of alcoholic cirrhosis in atherosclerosis of autopsied patients. Rev Assoc Med Bras (1992) 2017; 63:336-340. [PMID: 28614536 DOI: 10.1590/1806-9282.63.04.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 10/19/2016] [Indexed: 11/21/2022] Open
Abstract
Introduction: Alcoholism is a major public health problem, which has a high social cost and affects many aspects of human activity. Liver disease is one of the first consequences of alcohol abuse, and steatosis, liver cirrhosis and hepatitis may occur. Other organs are also affected with pathological changes, such as pancreatitis, cardiomyopathies, dyslipidemias and atherosclerosis. Objective: To identify the occurrence and degree of atherosclerosis in alcohol-dependent individuals with liver cirrhosis, observing macroscopic and microscopic changes in lipid and collagen deposits and in the liver. We also aimed to verify the association of lipid and collagen fiber deposits with gender, age and body mass index, and to relate alcoholism, liver cirrhosis and atherosclerosis. Method: We performed a study based on autopsy reports of patients with alcoholic liver cirrhosis, with analysis of aorta and liver fragments to verify the occurrence and degree of atherosclerosis, as well as collagen contents. Results: Microscopic atherosclerosis was higher in young subjects (early injury) and in patients with alcoholic liver cirrhosis. The macroscopic analysis of atherosclerosis in aortas showed that patients in more advanced age groups presented more severe classifications. Atherosclerosis, both micro and macroscopically, and the percentage of fibrosis in the liver and aorta were more expressive in females. Conclusion: Cirrhotic patients presented a higher percentage of fibrosis and lipidosis, and may represent a group susceptible to the accelerated progression of cardiovascular diseases. Investigative studies contribute to targeting health-promoting interventions, reducing the mortality and costs of treating cardiovascular disease.
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Affiliation(s)
- Luciano Alves Matias da Silveira
- General Pathology Sector, Biological and Natural Sciences Institute (ICBN), Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Bianca Gonçalves Silva Torquato
- General Pathology Sector, Biological and Natural Sciences Institute (ICBN), Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Mariana Silva Oliveira
- General Pathology Sector, Biological and Natural Sciences Institute (ICBN), Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Guilherme Ribeiro Juliano
- General Pathology Sector, Biological and Natural Sciences Institute (ICBN), Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Lívia Ferreira Oliveira
- General Pathology Sector, Biological and Natural Sciences Institute (ICBN), Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Camila Lourencini Cavellani
- General Pathology Sector, Biological and Natural Sciences Institute (ICBN), Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Luciana Santos Ramalho
- General Pathology Sector, Biological and Natural Sciences Institute (ICBN), Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Ana Paula Espindula
- General Pathology Sector, Biological and Natural Sciences Institute (ICBN), Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Vicente de Paula Antunes Teixeira
- General Pathology Sector, Biological and Natural Sciences Institute (ICBN), Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Mara Lúcia Fonseca Ferraz
- General Pathology Sector, Biological and Natural Sciences Institute (ICBN), Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
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Franconi F, Rosano G, Basili S, Montella A, Campesi I. Human cells involved in atherosclerosis have a sex. Int J Cardiol 2016; 228:983-1001. [PMID: 27915217 DOI: 10.1016/j.ijcard.2016.11.118] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/06/2016] [Indexed: 12/30/2022]
Abstract
The influence of sex has been largely described in cardiovascular diseases. Atherosclerosis is a complex process that involves many cell types such as vessel cells, immune cells and endothelial progenitor cells; however, many, if not all, studies do not report the sex of the cells. This review focuses on sex differences in human cells involved in the atherosclerotic process, emphasizing the role of sex hormones. Furthermore, we report sex differences and issues related to the processes that determine the fate of the cells such as apoptotic and autophagic mechanisms. The analysis of the data reveals that there are still many gaps in our knowledge regarding sex influences in atherosclerosis, largely for the cell types that have not been well studied, stressing the urgent need for a clear definition of experimental conditions and the inclusion of both sexes in preclinical studies.
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Affiliation(s)
- Flavia Franconi
- Assessorato alle Politiche per la Persona of Basilicata Region, Potenza, Italy; Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Giuseppe Rosano
- Cardiovascular and Cell Sciences Research Institute, St. George's University of London, United Kingdom
| | - Stefania Basili
- Department of Internal Medicine and Medical Specialties - Research Center on Gender and Evaluation and Promotion of Quality in Medicine (CEQUAM), Sapienza University of Rome, Italy
| | - Andrea Montella
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Ilaria Campesi
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy; Laboratory of Sex-Gender Medicine, National Institute of Biostructures and Biosystems, Osilo, Italy.
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Lima MCC, Romaldini CC, Romaldini JH. Frequency of obesity and related risk factors among school children and adolescents in a low-income community. A cross-sectional study. SAO PAULO MED J 2015; 133:125-30. [PMID: 26018882 PMCID: PMC10496638 DOI: 10.1590/1516-3180.2014.8960412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 05/23/2014] [Accepted: 12/04/2014] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE The frequency of obesity at an early age may contribute to atherosclerosis and cardiovascular disease (CVD) in adults. This study measured the frequency of obesity and cardiovascular risk factors in children and adolescents aged 6 to 17 years. DESIGN AND SETTING Cross-sectional study in a school located in a region of low income and socioeconomic status in Santa Rita do Sapucai, Minas Gerais, Brazil. METHODS A total of 175 students were classified using body mass index (BMI) and their waist circumference, blood pressure, number of hours of sedentary behavior and school meals were evaluated. Serum concentrations of fasting blood glucose, total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL-C) and high-density lipoprotein (HDL-C) were analyzed. RESULTS 37.2% of the students had BMI above the 85th percentile and had significantly lower age, higher prevalence of hypertension, higher serum TC, LDL-C and TG, and greater waist circumference than those with BMI below the 85th percentile. Hypertension was observed in 2.9% of the students; 5.1% presented impaired glucose tolerance, 40% had two risk factors for atherosclerosis and 26.9% had three risk factors. A sedentary lifestyle was significantly less prevalent among subjects with BMI above the 85th percentile and was significantly correlated with serum TC and LDL-C. The school meals were hypoglycemic, hyperproteic and hyperlipidemic. CONCLUSION One third of the children and adolescents had weights greater than or equal to the age-adjusted weight, and this was associated with greater waist circumference, hypertension and prevalence of dyslipidemia.
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Affiliation(s)
- Mariana Carvalheiro Cotrim Lima
- Master’s Student, Postgraduate Health Science Program, Hospital do Servidor Público Estadual (HSPE), Instituto de Assistência Médica ao Servidor Público Estadual (IAMSPE), São Paulo, Brazil.
| | - Ceres Concilio Romaldini
- MD, PhD. Professor, Postgraduate Health Science Program, Hospital do Servidor Público Estadual (HSPE), Instituto de Assistência Médica ao Servidor Público Estadual (IAMSPE), São Paulo, Brazil.
| | - João Hamilton Romaldini
- MD, PhD. Titular Professor of Endocrinology, Pontifícia Universidade Católica de Campinas (PUC-Campinas), and Professor, Postgraduate Health Science Program, Hospital do Servidor Público Estadual (HSPE), Instituto de Assistência Médica ao Servidor Público Estadual (IAMSPE), São Paulo, Brazil.
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