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1.
Talanta ; 256: 124262, 2023 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-36701855

RESUMO

A novel sorbent material employing magnetic nanoparticles (MNPs) coupled to graphene oxide (GO) functionalized with 4-aminobenzenesulfonic acid (M@GO-ABS) has been synthesized and applied to develop an inexpensive and automatic method for Cr(III) and Cr(VI) speciation in environmental samples; the developed method combines inductively coupled plasma optical emission spectrometry (ICP-OES) with on-line magnetic solid phase extraction (MSPE). Two magnetic-knotted reactors containing M@GO-ABS were installed in the eight-port injection valve of a flow injection (FI) manifold. Two different eluents were used, one for Cr(VI) (the most toxic chromium species) and one for total Cr concentration. Cr(III) concentration was calculated by the difference between Cr(VI) concentration and total Cr concentration. The optimized method presented detection limits (LOD, peak height) of 0.1 µg L-1 for chromium (VI) and 0.08 µg L-1 for total chromium, and enrichment factors of 15 and 23, respectively. Certified reference materials (TMDA 54.5 fortified lake water and SPS-SW2 surface water) and spiked aqueous samples were used to validate the developed method. The developed method was fruitfully applied to chromium speciation in environmental water samples such as seawater, well water and tap water collected in Málaga (Spain). The obtained values were in good agreement with the certified values, and the recoveries were found in the range of 91-108% for the spiked samples.

2.
Talanta ; 223(Pt 1): 121795, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33303177

RESUMO

The application of nanoparticles (NPs) in science and technology is a fast growing field. Therefore, reliable and straightforward analytical methods are required for their fast determination in different types of samples. This work investigates a method that enables the determination of ZnO NPs, discriminating them from ionic zinc in cosmetic samples. The method is based on direct solid sampling high-resolution continuum source electrothermal atomic absorption spectrometry (SS-HR-CS-GFAAS), and has been applied to determination of ZnO NPs, Zn2+ and total Zn in eye shadow samples. In this work the deconvolution of the atomization peak and the calibration by standard additions have been done in order to discriminate and quantify ionic zinc and ZnO NPs. A Zn wavelength with low sensitivity was selected. The proper optimization of the graphite furnace temperature program, minimizing the mineralization of the sample matrix, enables different atomization profiles between the different chemical species of the analyte. Two multiple response surface designs have been used in order to optimize the adequate furnace program to achieve our aims. All the optimization experiments were performed using a sample of eye shadow. Further, a method for the determination of total Zn by direct solid sampling with calibration by aqueous standards, was also optimized. The optimized method was successfully applied to the determination of ionic Zn and ZnO NPs in different eye shadow samples, and has been validated by recovery assays, obtaining recovery percentages between 80 and 125%. Total Zn concentration in the solid samples was validated by the determination of total Zn by direct solid sampling and by the analysis of the same eye shadow samples digested in microwave oven.

3.
Radiología (Madr., Ed. impr.) ; 62(3): 205-212, mayo-jun. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-194218

RESUMO

OBJETIVO: Presentar los resultados de un estudio multidisciplinar de dos hospitales terciarios, junto a los servicios de urología, sobre 102 pacientes consecutivos no candidatos a cirugía tratados durante más de 6 años, en los que se realizó embolización de arterias prostáticas para el tratamiento de la hiperplasia benigna. MATERIAL Y MÉTODOS: Desde diciembre de 2012 a febrero de 2019, 102 pacientes con síntomas de hiperplasia benigna de la próstata (HBP) no candidatos a cirugía o que la rechazaron explícitamente, con una edad media de 73,9 años (rango 47,5-94,5), fueron sometidos a embolización prostática. Se llevó a cabo un seguimiento de estos a través de cuestionarios sobre la sintomatología urinaria, función sexual e impacto en la calidad de vida, así como la medición del volumen prostático, uroflujometría y antígeno prostático específico (PSA) al mes, 3 y 6 meses y al año del procedimiento. RESULTADOS: La técnica fue exitosa en un 96% de los pacientes (76,2% bilateral y 19,8% unilateral). El tiempo de duración media del procedimiento fue de 92 minutos y el de radioscopia, de 35,2 minutos. Se demostraron cambios estadísticamente significativos (p < 0,05) en el PSA, el flujo urinario pico (Qmáx), el cuestionario QoL (Quality of life) y el International Index of Erectile Function (IPSS). El PSA disminuyó un 58% a los 3 meses respecto al valor inicial. Asimismo, el Qmáx aumentó de manera significativa en un 63% al tercer mes tras la embolización. Se obtuvo una mejoría significativa en los test QoL e IPSS, con una disminución de 3,7 puntos y 13,5 puntos de media, respectivamente, al año de seguimiento. El volumen prostático mostró una disminución no estadísticamente significativa al año, tras el tratamiento. Se han recogido una serie de complicaciones menores, que en ningún caso requirieron ingreso hospitalario. CONCLUSIONES: La embolización prostática para el tratamiento de la HPB demostró ser una técnica eficaz y segura en pacientes no candidatos a cirugía


OBJECTIVE: To present the results of a multidisciplinary study of two tertiary hospitals, together with urology services, on 102 consecutive patients not candidates for surgery treated for more than 6 years, in whom prostatic arteries were embolised for the treatment of benign hyperplasia. MATERIAL AND METHODS: From December 2012 to February 2019, 102 patients with symptoms of benign prostatic hyperplasia (BPH) not candidates for surgery or who explicitly rejected surgery, with an average age of 73.9 years (range 47.5-94.5), underwent prostatic artery embolisation. The patients were followed up by questionnaires on urinary symptoms, sexual function and impact on quality of life, as well as measurement of prostate volume, uroflowmetry and prostate specific antigen (PSA) at one, 3 and 6 months and one year following the procedure. RESULTS: The technique was successful in 96% of patients (76.2% bilateral and 19.8% unilateral). The mean duration of the procedure was 92minutes and of the radioscopy 35.2minutes. Statistically significant changes were demonstrated (p <.05) in PSA, peak urinary flow, QoL (quality of life) questionnaire and the International Index of Erectile Function (IPSS). PSA had reduced by 58% from baseline at 3 months. Similarly, the Qmax had increased significantly by 63% in the third month following embolisation. A significant improvement in the QoL and IPSS tests was achieved, with a reduction of 3.7 points and a mean 13.5 points, respectively, at one year's follow-up. Prostate volume showed a non-statistically significant decrease at follow-up of one year following treatment. A series of minor complications was collected, no case of which required hospital admission. CONCLUSIONS: Prostatic embolisation for the treatment of BPH proved an effective and safe technique in patients who were not candidates for surgery


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Embolização Terapêutica , Artérias/diagnóstico por imagem , Próstata/diagnóstico por imagem , Hiperplasia Prostática/diagnóstico por imagem , Comunicação Interdisciplinar , Artérias/patologia , Inquéritos e Questionários , Qualidade de Vida , Reologia/métodos , Antígeno Prostático Específico , Estudos Prospectivos , Angiografia/métodos , Fluoroscopia/métodos
4.
Radiologia (Engl Ed) ; 62(3): 205-212, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31757401

RESUMO

OBJECTIVE: To present the results of a multidisciplinary study of two tertiary hospitals, together with urology services, on 102 consecutive patients not candidates for surgery treated for more than 6 years, in whom prostatic arteries were embolised for the treatment of benign hyperplasia. MATERIAL AND METHODS: From December 2012 to February 2019, 102 patients with symptoms of benign prostatic hyperplasia (BPH) not candidates for surgery or who explicitly rejected surgery, with an average age of 73.9 years (range 47.5-94.5), underwent prostatic artery embolisation. The patients were followed up by questionnaires on urinary symptoms, sexual function and impact on quality of life, as well as measurement of prostate volume, uroflowmetry and prostate specific antigen (PSA) at one, 3 and 6 months and one year following the procedure. RESULTS: The technique was successful in 96% of patients (76.2% bilateral and 19.8% unilateral). The mean duration of the procedure was 92minutes and of the radioscopy 35.2minutes. Statistically significant changes were demonstrated (p <.05) in PSA, peak urinary flow, QoL (quality of life) questionnaire and the International Index of Erectile Function (IPSS). PSA had reduced by 58% from baseline at 3 months. Similarly, the Qmax had increased significantly by 63% in the third month following embolisation. A significant improvement in the QoL and IPSS tests was achieved, with a reduction of 3.7 points and a mean 13.5 points, respectively, at one year's follow-up. Prostate volume showed a non-statistically significant decrease at follow-up of one year following treatment. A series of minor complications was collected, no case of which required hospital admission. CONCLUSIONS: Prostatic embolisation for the treatment of BPH proved an effective and safe technique in patients who were not candidates for surgery.


Assuntos
Embolização Terapêutica/métodos , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Idoso , Idoso de 80 Anos ou mais , Angiografia , Artérias/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Centros de Atenção Terciária , Resultado do Tratamento , Micção
5.
Talanta ; 184: 251-259, 2018 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-29674040

RESUMO

Arsenic, one of the main environmental pollutants and potent natural poison, is a chemical element that is spread throughout the Earth's crust. It is well known that the toxicity of arsenic is highly dependent on its chemical forms. Generally, the inorganic species are more toxic than its organics forms, and As(III) is 60 times more toxic than As(V). In environmental waters, arsenic exists predominantly in two chemical forms: As(III) and As(V). In view of these facts, fast, sensitive, accurate and simple analytical methods for the speciation of inorganic arsenic in environmental waters are required. In this work, a new magnetic solid phase extraction with a hydride generation system was coupled on line with inductively coupled plasma mass spectrometry (MSPE-HG-ICP-MS). The new system was based on the retention of As(III) and As(V) in two knotted reactors filled with (Fe3O4) magnetic nanoparticles functionalized with [1,5-bis (2-pyridyl) 3-sulfophenylmethylene] thiocarbonohydrazide (PSTH-MNPs). As(III) and total inorganic As were sequentially eluted in different reduction conditions. The concentration of As(V) was obtained by subtracting As(III) from total As. The system runs in a fully automated way and the method has proved to have a wide linear range and to be precise, sensitive and fast. The detection limits found were 2.7 and 3.2 ng/L for As(III) and total As, respectively; with relative standard deviations (RSDs) of 2.5% and 2.7% and a sample throughput of 14.4 h-1. In order to validate the developed method, several certified reference samples of environmental waters including sea water, were analyzed and the determined values were in good agreement with the certified values. The proposed method was successfully applied to the speciation analysis of inorganic arsenic in well-water and sea water.

6.
Talanta ; 179: 1-8, 2018 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-29310207

RESUMO

A green and simple method has been proposed in this work for the simultaneous determination of V, Ni and Fe in fuel ash samples by solid sampling high resolution continuum source graphite furnace atomic absorption spectrometry (SS HR CS GFAAS). The application of fast programs in combination with direct solid sampling allows eliminating pretreatment steps, involving minimal manipulation of sample. Iridium treated platforms were applied throughout the present study, enabling the use of aqueous standards for calibration. Correlation coefficients for the calibration curves were typically better than 0.9931. The concentrations found in the fuel ash samples analysed ranged from 0.66% to 4.2% for V, 0.23-0.7% for Ni and 0.10-0.60% for Fe. Precision (%RSD) were 5.2%, 10.0% and 9.8% for V, Ni and Fe, respectively, obtained as the average of the %RSD of six replicates of each fuel ash sample. The optimum conditions established were applied to the determination of the target analytes in fuel ash samples. In order to test the accuracy and applicability of the proposed method in the analysis of samples, five ash samples from the combustion of fuel in power stations, were analysed. The method accuracy was evaluated by comparing the results obtained using the proposed method with the results obtained by ICP OES previous acid digestion. The results showed good agreement between them. The goal of this work has been to develop a fast and simple methodology that permits the use of aqueous standards for straightforward calibration and the simultaneous determination of V, Ni and Fe in fuel ash samples by direct SS HR CS GFAAS.

7.
Rev Esp Med Nucl Imagen Mol ; 36(4): 241-246, 2017.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28330596

RESUMO

OBJECTIVES: To study 18F-Choline PET/CT in the diagnosis and biopsy guide of prostate cancer (pCa) in patients with persistently high prostate-specific antigen (PSA) and previous negative prostate biopsy. To compare the clinical risk factors and metabolic variables as predictors of malignancy. METHODS: Patients with persistently elevated PSA in serum (total PSA >4ng/mL) and at least a previous negative or inconclusive biopsy were consecutively referred for a whole body 18F-Choline PET/CT. Patient age, PSA level, PSA doubling time (PSAdt) and PSA velocity (PSAvel) were obtained. PET images were visually (positive or negative) and semiquantitatively (SUVmax) reviewed. 18F-Choline uptake prostate patterns were defined as focal, multifocal, homogeneous or heterogeneous. Histology on biopsy using transrectal ultrasound-guided approach was the gold standard. Sensitivity (Se), specificity (Sp) and accuracy (Ac) of PET/CT for diagnosis of pCa were evaluated using per-patient and per-prostate lobe analysis. Receiver-operating-characteristic (ROC) curve analysis was used to assess the value of SUVmax to diagnose pCa. Correlation between PET/CT and biopsy results per-prostate lobe was assessed using the Chi-square test. Univariate and multivariate logistic regression analysis were applied to compare clinical risk factors and metabolic variables as predictors of malignancy. RESULTS: Thirty-six out of 43 patients with histologic confirmation were included. In 11 (30.5%) patients, pCa was diagnosed (Gleason score from 4 to 9). The mean values of patient age, PSA level, PSAdt and PSAvel were: 65.5 years, 15.6ng/ml, 28.1 months and 8.5ng/mL per year, respectively. Thirty-three patients had a positive PET/CT; 18 had a focal pattern, 7 multifocal, 4 homogeneous and 4 heterogeneous. Se, Sp and Ac of PET/CT were of 100%, 12% and 38% in the patient based analysis, and 87%, 29% and 14% in the prostate lobe based analysis, respectively. The ROC curve analysis of SUVmax showed an AUC of 0.568 (p=0.52). On a lobe analysis, poor agreement was observed between PET/CT findings and biopsy results (p=0.097). In the univariate/multivariate analysis, none of clinical and metabolic variables were statistically significant as predictor of pCa. CONCLUSION: Choline PET/CT is a suitable procedure for the detection of pCa in highly selected patients, however, a high rate of false positive should be expected.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Biópsia por Agulha/métodos , Biópsia Guiada por Imagem/métodos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/diagnóstico por imagem , Imagem Corporal Total , Adenocarcinoma/sangue , Adenocarcinoma/patologia , Idoso , Colina , Reações Falso-Positivas , Radioisótopos de Flúor , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Prostatite/diagnóstico por imagem , Sensibilidade e Especificidade
8.
Actas Urol Esp ; 39(8): 502-10, 2015 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-25944771

RESUMO

INTRODUCTION: The aim of this study was to analyze and compare the capacity of procalcitonin (PCT), C-reactive protein (CRP), lactate and leukocytes to predict the presence of bacteremia in patients with urinary tract infections (UTIs). METHODS: Observational, retro-prospective analytical study of adult patients (≥15 years) diagnosed with UTI in an emergency department from August 2012 to January 2013. RESULTS: The study included 328 patients diagnosed with UTI, with a mean age of 52±22 years, 74% of whom were women. Of these, 43 (13.1%) had bacteremia. For predicting bacteremia, PCT achieved the largest area under the receiver operating characteristic curve (ROC-AUC) at .993 (95% CI .987-1; P<.001). A cutoff≥1.16ng/mL achieves a sensitivity of 100%, a specificity of 97%, a positive predictive value of 84% and a negative predictive value of 100%. Lactate achieved an ROC-AUC of .844, and CRP achieved only .534. The mean values when comparing PCT levels in patients with UTIs with and without bacteremia were 8.08±16.37 and .34±.37ng/mL, respectively (P<.001). CONCLUSIONS: For patients with UTIs in the emergency department, PCT achieves considerable diagnostic performance for suspecting bacteremia, a performance greater than that of lactate, CRP and leukocytes.


Assuntos
Bacteriemia/sangue , Bacteriemia/etiologia , Proteína C-Reativa/análise , Calcitonina/sangue , Infecções Urinárias/complicações , Adulto , Bacteriemia/diagnóstico , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Estudos Retrospectivos
9.
Talanta ; 129: 1-8, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25127557

RESUMO

A simple, sensitive, low-cost and rapid flow injection (FI) on-line sorption preconcentration/hydride generation system has been synchronously coupled to an electrothermal atomic absorption spectrometer (ETAAS) for the determination of trace amounts of Sb in aqueous environmental samples (river and sea water samples). The system is based on retention of the analyte onto a micro-column filled with a novel mesoporous silica functionalised with [1,5 bis(di-2-pyridyl) methylene] thiocarbohydrazide placed in the injection valve of the FI manifold. The adsorption capacity of the resin for Sb was found to be 160.8 µmol g(-1). Chemicals and flow variables affecting the continuous preconcentration of antimony, the direct generation of antimony hydride and the final determination of this element by ETAAS were evaluated. The optimized operating conditions selected were: sample pH 5.0, sample flow rate 2.5 ml min(-1), eluent flow rate 5.4 ml min(-1), eluent 2.0% thiourea in 4.0% nitric acid. Under the optimum conditions, the calibration graph obtained was linear over the range 0.025-2.5 µg L(-1). At a sample frequency of 20 h(-1) and 120 s preconcentration time, the enrichment factor was 22. The detection limit of the method (3Æ¡) was 1 ng L(-1) for a 5.0 mL sample volume and the precision was 0.9% (RSD) for 11 replicate determinations at 1.0 µg L(-1) Sb. The preconcentration factor and detection limit can be improved by increasing the preconcentration time, which can be increased at least up to 5 min. The accuracy of the proposed method was demonstrated by analyzing two certified reference materials and by determining the analyte content in spiked environmental water samples. The results obtained using this method were in good agreement with the certified values of the standard reference materials and the recoveries for the spiked river and sea water samples were 91.3-109.9%.


Assuntos
Antimônio/análise , Hidrazinas/química , Hidrazinas/síntese química , Piridinas/química , Piridinas/síntese química , Dióxido de Silício/química , Dióxido de Silício/síntese química , Poluentes Químicos da Água/análise , Adsorção , Antimônio/química , Calibragem , Quelantes/química , Monitoramento Ambiental/métodos , Água Doce/química , Grafite/química , Concentração de Íons de Hidrogênio , Limite de Detecção , Valores de Referência , Reprodutibilidade dos Testes , Água do Mar/química , Solventes/química , Espectrofotometria Atômica/métodos , Oligoelementos/análise
10.
Arch Gynecol Obstet ; 279(2): 171-4, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18437406

RESUMO

BACKGROUND: Malignant tumours of the vulvar soft tissue are very uncommon. When localized in the Bartholin's gland area these tumours can be mistaken for benign lesions, leading to a delayed diagnosis. CASE: A 52-year-old woman presenting with a vulvar nodule, which was diagnosed as a Bartholin's gland cyst and was referred to the hospital for surgical excision of the lesion. Pathologist report informed of a 6 cm diameter leiomyosarcoma of the vulva with compromised resection margins; extension studies did not suggest any additional lesions and radical hemivulvectomy with ipsilateral inguinal lymphadenectomy was performed. The patient subsequently received radiotherapy and chemotherapy. Twelve months later, a local recurrence was diagnosed and was removed surgically. After 4 years of follow-up the patient remains disease free. CONCLUSION: Any vulvar lesion with unusual characteristics or insidious evolution in labia majora or Bartholin's glands area should be carefully and promptly studied. This is particularly important in order to perform an effective surgical treatment in cases of leiomyosarcoma.


Assuntos
Glândulas Vestibulares Maiores/patologia , Leiomiossarcoma/diagnóstico , Neoplasias Vulvares/diagnóstico , Quimioterapia Adjuvante , Diagnóstico Diferencial , Feminino , Virilha , Humanos , Leiomiossarcoma/patologia , Leiomiossarcoma/cirurgia , Excisão de Linfonodo , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Radioterapia Adjuvante , Neoplasias Vulvares/patologia , Neoplasias Vulvares/cirurgia
11.
Anal Chim Acta ; 582(1): 92-7, 2007 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-17386479

RESUMO

Simultaneous determination of non-fluorescent glycols in mixtures without separation or chemical transformation steps is described. Two methods based in the measure of fluorescence anisotropy of a probe such as fluorescein dissolved in the analyte or analyte mixtures are described. In the first method, the anisotropy spectra of pure and mixtures of analytes are used to quantitative determination (if the fluorophor concentration is in a range where fluorescence intensity is proportional to concentration). In the second method, a calibration curve anisotropy-concentration based on the application of the Perrin equation is established. The methods presented here are capable of directly resolving binary mixtures of non-fluorescent glycols on the basis of differences on the fluorescence anisotropy of a fluorescence tracer. Best analytical performances were obtained by application of the method based on Perrin equation. This method is simple, rapid and allows the determination of mixtures of glycols with reasonable accuracy and precision. Detection limits are limited by the quantum yield and anisotropy values of the tracer in the solvents. Recovery values are related to the differences in anisotropy values of the tracer in the pure solvents. Mixtures of glycerine/ethylene glycol (GL/EG), ethylene glycol/1,2-propane diol (EG/1,2-PPD) and polyethylene glycol 400/1,2-propane diol (PEG 400/1,2-PPD) were analysed and recovery values are within 95-120% in the Perrin method. Relative standard deviation are in the range 1.3-2.9% and detection limits in the range 3.9-8.9%.

12.
Talanta ; 60(2-3): 629-34, 2003 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-18969086

RESUMO

Two individual components in mixtures have been resolved by frequency domain fluorescence technique by measuring the observable quantities which characterize the anisotropy decay; differential anisotropy phase and modulated anisotropy ratio (MAR), which in turn are related to the rotational correlation time. The method presented here is capable of directly resolving binaries mixtures of fluorophores on the basis of differences in their rotational diffusion rates. Our results demonstrate that modulation anisotropy ratio measurements can be used for quantitative determination of small analytes, carbaryl and benomyl, having identical or nearly identical fluorescence spectra. This methodology can be applied with good results when the fluorophores have a suitable MAR difference.

13.
Acta Otorrinolaringol Esp ; 45(3): 173-6, 1994.
Artigo em Espanhol | MEDLINE | ID: mdl-8068359

RESUMO

The authors made an audiological screening of the entire population of the Valle de los Pedroches entering primary education in 1992. The auditory levels of the children were measured and abnormalities were detected. In a total of 440 children, 43 hypoacusic cases were found. The type of hypoacusis was predominanthy conductive (95.4%), serous otitis media, being the most common cause of hypoacusis in infancy. We deduce that screening is useful for detecting this medical problem.


Assuntos
Orelha Média/fisiopatologia , Perda Auditiva Condutiva/diagnóstico , Perda Auditiva Condutiva/fisiopatologia , Testes de Impedância Acústica , Otorreia de Líquido Cefalorraquidiano/diagnóstico , Criança , Feminino , Perda Auditiva Condutiva/epidemiologia , Humanos , Masculino , Otite Média com Derrame/epidemiologia , Otite Média com Derrame/fisiopatologia , Prevalência , Fatores Sexuais , Espanha/epidemiologia
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