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Original article
Influence of the lockdown due to COVID-19 on weight-loss results during the first year after sleeve gastrectomy
Influencia del confinamiento por COVID-19 en los resultados ponderales durante el primer año tras la gastrectomía vertical
David Ruiz de Anguloa,
Corresponding author
druizdeangulo@hotmail.com

Corresponding author.
, Andrés Balaguer Románb, Vicente Munitiz Ruiza, Pedro José Gil Vázquezb, Guadalupe Ruiz Merinoc, M. Ángeles Ortiz Escandella, Luisa F. Martínez de Haroa, Pascual Parrilla Paricioa
a Unidad de Cirugía Esofagogástrica y Obesidad, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
b Servicio de Cirugía General y Aparato Digestivo, Hospìtal Universitario Virgen de la Arrixaca, Murcia, Spain
c Unidad de Bioestadística, Instituto Murciano de Investigación Biosanitaria (IMIB), Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Severe acute respiratory syndrome coronavirus 2 &#40;SARS-CoV-2&#41; is the most important pandemic that humans have experienced as a species in recent decades&#44; causing thousands of deaths around the world&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">1</span></a> In Spain&#44; as in other countries&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">2</span></a> the population was confined to their homes for much of the month of March and the entire month of April&#44; followed by different phases of de-escalation&#46; The difficulty to perform normal physical activity during this period&#44; as well as the appearance or worsening of different psychological syndromes derived from this situation&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">3</span></a> leads us to assume that the short-term weight-loss results after bariatric surgery would not be ideal&#46; Since the first year after bariatric surgery is very important to achieve considerable weight loss&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">4</span></a> and given the consequent motivational implications and positive reinforcement resulting from this phenomenon&#44; we believe that it is of great importance to quantify the influence that confinement has had on our patients&#46; This is especially true since the epidemiological situation is still not under control&#44; and it is unknown whether the appearance of new outbreaks will again require drastic social isolation measures in the near future&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Therefore&#44; our objective is to quantify the weight-loss results obtained in patients whose first postoperative year included the period of confinement due to COVID-19&#46; These results were compared with those from a control group whose first year after the bariatric procedure was not affected by the consequences of confinement due to the pandemic&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">In the Esophagogastric Surgery and Obesity Unit of the Hospital Universitario Virgen de la Arrixaca&#44; we conducted this retrospective study of cases and controls using a prospective database&#44; data obtained through telephone consultations&#44; and data recorded in computerized patient medical records&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Group 1 &#40;cases&#41; included patients who underwent laparoscopic sleeve gastrectomy &#40;SG&#41; from May 2019 to May 2020 and who were therefore affected by the lockdown during the first postoperative year&#46; We collected epidemiological characteristics and the current weight of the patients&#44; as well as the time since the operation&#44; in months&#46; Group 2&#44; the control group&#44; was obtained from cases treated by our unit prior to the study period &#40;March 2013&#8211;May 2019&#41; and included twice as many patients as the cases from group 1&#46; The cases and controls were organized by periods according to the time elapsed since the operation&#44; and twice as many control cases were randomly chosen as patients&#46; In other words&#44; if the weight after one month was available for one case&#44; the weight after one month was collected for 2 controls &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The selection of the control patients in group 2 was carried out using a random numerical sequence in the general database of our registered cases&#44; where patients are organized chronologically by the date of surgery&#46; Therefore&#44; in the results&#44; the numerical values of the percentage of excess weight lost &#40;&#37;EWL&#41; or the percentage of total weight lost &#40;&#37;TWL&#41; in each group were not relevant&#44; since they represent mean patient weight at different times after surgery&#46; What is interesting is the comparison between groups&#44; since we tried to eliminate this bias by creating a control group with exactly twice the number of determinations&#44; but at the same moments in time after the operation&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The surgical technique has undergone no modifications since the beginning of our surgical activity&#44; and certain details have been described in previous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">5&#44;6</span></a> The &#37;EWL was calculated with the Metropolitan Life Insurance formula&#59; the &#37;TWL for each patient in the two groups and their means were compared between cases and controls&#46; A descriptive statistical analysis was conducted for each of the variables contemplated&#44; using the median &#40;range&#41; and the mean &#40;standard deviation&#41; for continuous variables depending on whether their distribution was non-normal or normal&#44; respectively&#46; The distribution of these variables was analyzed using the Kolmogorov&#8211;Smirnov or Shapiro&#8211;Wilk statistical tests&#44; as appropriate&#46; For qualitative variables&#44; absolute frequencies and their relative frequencies were used&#46; For the study of the relationship between the variables&#44; the chi-square test was applied&#44; including the analysis of residuals between 2 qualitative variables&#44; the Pearson correlation if the variables were quantitative&#44; and the comparison of means &#40;Student&#39;s <span class="elsevierStyleItalic">t</span>&#41; or the Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span>&#44; as appropriate for the study of the relationship between a qualitative and a quantitative variable&#46; In all situations&#44; an association with a <span class="elsevierStyleItalic">P</span> value less than &#46;05 was considered statistically significant&#46; All data were analyzed with IBM SPSS statistics v&#46;24 &#40;SPSS&#44; Inc&#46; Chicago&#44; IL&#44; USA&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0030" class="elsevierStylePara elsevierViewall">From May 2019 to May 2020&#44; 20 patients &#40;group 1&#41; underwent SG in our unit&#46; Specifically&#44; and as of this writing&#44; 6 patients underwent surgery 10 months ago&#44; 2 patients 7 months ago&#44; 2 patients 6 months ago&#44; 4 patients 5 months ago&#44; 2 patients 4 months ago&#44; one patient 3 months ago&#44; 2 patients 2 months ago&#44; and one patient had only one month of postoperative follow-up &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Group 2 was made up of 40 patients evenly distributed among the different postoperative follow-up times at a ratio of 1&#58;2 &#40;one case for every 2 control subjects&#41;&#46; Group 2 is homogeneous with group 1&#44; as shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; There were no differences between the two groups in terms of age&#44; sex&#44; presence of comorbidities&#44; diabetes&#44; arterial hypertension&#44; dyslipidemia&#44; or obstructive sleep apnea &#40;OSA&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Regarding the assessment of the weight-loss results&#44; we observed that there were no statistically significant differences in either the &#37;EWL or &#37;TWL between the two groups&#44; although poorer results were observed in the patients in group 1 &#40;&#37;EWL<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>47&#46;37<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;59&#59; &#37;TWL<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&#46;14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;17&#41; versus group 2 &#40;&#37;EWL<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51&#46;13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;59&#59; &#37;TWL<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>24&#46;67<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;01&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Bariatric surgery is the most effective and long-lasting treatment for morbid obesity today&#46; Several studies support its cost-benefit ratio by providing a significant reduction in weight&#44; as well as the resolution or substantial improvement of various associated comorbidities&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">7&#44;8</span></a> All this results in lower pharmaceutical costs&#44; as well as the greater work capacity and productivity of these patients&#46; However&#44; weight loss is more evident during the first year after the procedure&#44; which increases motivation and establishes healthy lifestyle habits in many patients&#46; One of these pillars is physical activity&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">9</span></a> which is especially important in subjects who have undergone a restrictive technique like SG&#44; and a physical training program has been shown to prevent weight regain in the medium term&#44; reducing body fat&#44; glycemia and cholesterol&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">10</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">As a result of COVID-19&#44; the Spanish population was confined to their homes&#44; which reduced the mobility and physical exercise of most individuals&#44; causing stress and fear in addition to addictions&#44; depression&#44; and even suicide&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">11&#8211;14</span></a> In this context&#44; it would be concerning if bariatric surgery did not meet the excellent previous results and durability&#44; since its cost-effectiveness could be called into question&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In our study&#44; we were unable to demonstrate that confinement had a decisive or significant effect on short-term weight results&#44; although poorer results were observed&#46; We believe&#44; however&#44; that an increase in the number of cases could amplify this difference&#44; since a preliminary calculation of the sample size required the recruitment of 135 patients per group&#44; which was impossible in our case&#46; Another limitation of the study is that some weight data of the patients in group 1 were obtained over the telephone&#44; with possible variabilities resulting from the moment and the tool with which they were calculated&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Several authors have denounced the injustice that the approach to the COVID-19 pandemic has represented for the morbidly obese&#46; This is mainly because other surgical procedures have been prioritized over bariatric surgery&#44; and there has also been increased stigmatization that this situation has generated in this subgroup of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">15</span></a> Other authors have described prioritization protocols for both bariatric and metabolic surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">16</span></a> Even so&#44; it is difficult to guess the evolution of the pandemic and whether confinement and social isolation will be imposed again&#46; Bariatric surgery is the best treatment for thousands of people who have a serious illness&#44; so we must demand its continuity from the competent authorities&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">17</span></a> Nevertheless&#44; we must ensure that treatment results will continue to meet the established standards&#46; Given the unpredictable evolution of the global COVID-19 pandemic&#44; the nutritional and psychological support of patients undergoing surgery as well as those on the surgical waiting list<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">18</span></a> should be fomented&#46; In addition&#44; the frequency of multidisciplinary committees should be increased in order to establish priorities until the healthcare situation is normalized&#46; Finally&#44; further studies are necessary with a greater number of patients to determine the actual influence that the confinement &#40;and potential future confinements&#41; has had on weight-loss results in order to develop transparent&#44; effective protocols&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="par0060" class="elsevierStylePara elsevierViewall">The confinement of the population in Spain during the months of March&#44; April and May 2020 did not significantly alter the &#37;EWL or the &#37;TWL of patients who underwent SG compared to patients whose first postoperative year was not affected by the COVID-19 pandemic&#46; However&#44; more studies with larger samples are necessary to reach more solid conclusions&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interests</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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            1 => "Vertical gastrectomy"
            2 => "Sleeve gastrectomy"
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            4 => "Lockdown"
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            0 => "Cirug&#237;a bari&#225;trica"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">COVID-19 pandemic has lead to lockdown of population in many countries&#46; In Spain&#44; the state of alarm was established from March 15 to June 20&#44; 2020&#46; Usually this fact decreased people&#39;s mobility and physical activity&#44; in addition to producing or exacerbating psychological disorders&#46; Our aim was to determine the influence that this condition had over the short-term ponderal results of patients undergoing laparoscopic vertical gastrectomy from May 2019 to May 2020&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Case&#8211;control study for comparing the percentage of excess weight lost &#40;&#37;EWL&#41; and the percentage of total weight lost &#40;&#37;TWL&#41; of patients that underwent a VG during the last year&#44; so they were affected by lockdown in April and part of March 2020 &#40;group 1&#41;&#44; to the &#37;EWL and &#37;TWL of a control group &#40;group 2&#41;&#44; obtained from our previous series&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The mean &#37;EWL in group 1 is 47&#46;37<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;59 and in group 2 is 51&#46;13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;59&#44; being <span class="elsevierStyleItalic">P</span>&#61;&#46;438&#46; Meanwhile&#44; the mean &#37;TWL in group 1 is 21&#46;14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;17 and in group 2 is 24&#46;67<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;01&#44; with <span class="elsevierStyleItalic">P</span>&#61;&#46;115&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Population lockdown by COVID-19 did not get worse short-term results of vertical gastrectomy&#46; More studies with a larger number of patients are necessary to draw firm conclusions&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La pandemia por COVID-19<span class="elsevierStyleHsp" style=""></span>ha obligado al confinamiento de la poblaci&#243;n en muchos pa&#237;ses&#46; En Espa&#241;a&#44; el estado de alarma se estableci&#243; desde el 15 de marzo al 20 de junio del 2020&#46; Este hecho&#44; por lo general&#44; disminuy&#243; la movilidad y la actividad f&#237;sica de las personas&#44; adem&#225;s de producir o exacerbar alteraciones psicol&#243;gicas&#46; Nuestro objetivo es analizar la influencia que esta situaci&#243;n ha ejercido sobre los resultados ponderales a corto plazo de los pacientes tratados mediante una gastrectom&#237;a vertical laparosc&#243;pica entre mayo del 2019 y mayo del 2020&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">M&#233;todos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Estudio de casos y controles donde se compararon el porcentaje de exceso de peso perdido &#40;&#37;EWL&#41; y el porcentaje de peso total perdido &#40;&#37;TWL&#41; de los pacientes intervenidos en el &#250;ltimo a&#241;o y a los que ha afectado el confinamiento durante el mes de abril y parte de marzo del 2020 &#40;grupo 1&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&#44; con el de un grupo control &#40;grupo 2&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41; de nuestra casu&#237;stica previa&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El &#37;EWL medio en el grupo 1 es de 47&#44;37<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#44;59 y en el grupo 2 es de 51&#44;13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#44;59&#44; siendo la p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;438&#46; Por su parte&#44; el &#37;TWL medio en el grupo 1 es de 21&#44;14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;17 mientras que en el grupo 2 es de 24&#44;67<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;01&#44; resultando la p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;115&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusiones</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">El confinamiento de la poblaci&#243;n por COVID-19 no empeor&#243; los resultados ponderales a corto plazo de la gastrectom&#237;a vertical&#46; Son necesarios m&#225;s estudios con un mayor n&#250;mero de pacientes para obtener conclusiones m&#225;s s&#243;lidas&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Ruiz de Angulo D&#44; Balaguer Rom&#225;n A&#44; Munitiz Ruiz V&#44; Gil V&#225;zquez PJ&#44; Ruiz Merino G&#44; Ortiz Escandell M&#193;&#44; et al&#46; Influence of the lockdown due to COVID-19 on weight-loss results during the first year after sleeve gastrectomyInfluence of the lockdown due to COVID-19 on weight-loss results during the first year after sleeve gastrectomy&#46; Cir Esp&#46; 2021&#59;99&#58;428&#8211;432&#46;</p>"
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                  \t\t\t\t">44&#46;90<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;37&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">44&#46;57<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#46;062&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Presence of comorbidities &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16 &#40;80&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">30 &#40;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#46;756&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#46;760&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#46;582&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">OSA &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">47&#46;37<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;59&nbsp;\t\t\t\t\t\t\n
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos