metricas
covid
Buscar en
Clinics
Toda la web
Inicio Clinics Seroconversion in asymptomatic COVID-19 pediatric patients with rheumatic diseas...
Journal Information

Statistics

Follow this link to access the full text of the article

Original articles
Seroconversion in asymptomatic COVID-19 pediatric patients with rheumatic diseases of one tertiary referral hospital
Juliana R. Simona,
Corresponding author
julianarussosimon@gmail.com

Corresponding author.
, Maria F.B. Pereirab, Heloisa H. Marquesb, Adriana M. Eliasa, Neusa K. Sakitad, Juliana C.O.A. Ferreirad, Alexander Roberto Preciosoe,f, Sandra J.F.E. Grisig, Ana Paula S. Ferrerg, Vera Bainb, Clovis A. Silvaa,c, Lúcia M.A. Camposa
a Pediatric Rheumatology Unit, Instituto da Criança e do Adolescente, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
b Pediatric Infectology Unit, Instituto da Criança e do Adolescente, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
c Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
d Clinical Research Center, Instituto da Criança e do Adolescente, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
e Department of Infectious and Parasitic Diseases, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
f Division of Clinical Trials and Pharmacovigilance, Instituto Butantan, São Paulo, SP, Brazil
g Instituto da Criança e do Adolescente, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
Read
1139
Times
was read the article
462
Total PDF
677
Total HTML
Share statistics
 array:23 [
  "pii" => "S1807593222033117"
  "issn" => "18075932"
  "doi" => "10.1016/j.clinsp.2022.100110"
  "estado" => "S300"
  "fechaPublicacion" => "2022-01-01"
  "aid" => "100110"
  "copyright" => "HCFMUSP"
  "copyrightAnyo" => "2022"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Clinics. 2022;77C:"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S1807593222033208"
    "issn" => "18075932"
    "doi" => "10.1016/j.clinsp.2022.100119"
    "estado" => "S300"
    "fechaPublicacion" => "2022-01-01"
    "aid" => "100119"
    "copyright" => "HCFMUSP"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Clinics. 2022;77C:"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original articles</span>"
      "titulo" => "Melatonin protects against ovarian damage by inhibiting autophagy in granulosa cells in rats"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "en"
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0003"
          "etiqueta" => "Fig&#46; 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 1161
              "Ancho" => 2917
              "Tamanyo" => 162323
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "alt0005"
              "detalle" => "Fig "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spara003" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">The protective effect of MT on ovarian granulosa cells in each group of rats&#46;</span> &#40;a&#41; The survival of rat ovarian granulosa cells in each group was detected by the CCK8 method&#46; &#40;b&#41; The death of ovarian granulosa cells in each group was detected by the LDH method&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Yan Liu, Xiaohe Zhu, Chunli Wu, Yan Lang, Wenjie Zhao, Yanmin Li"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Yan"
              "apellidos" => "Liu"
            ]
            1 => array:2 [
              "nombre" => "Xiaohe"
              "apellidos" => "Zhu"
            ]
            2 => array:2 [
              "nombre" => "Chunli"
              "apellidos" => "Wu"
            ]
            3 => array:2 [
              "nombre" => "Yan"
              "apellidos" => "Lang"
            ]
            4 => array:2 [
              "nombre" => "Wenjie"
              "apellidos" => "Zhao"
            ]
            5 => array:2 [
              "nombre" => "Yanmin"
              "apellidos" => "Li"
            ]
          ]
        ]
      ]
      "resumen" => array:1 [
        0 => array:3 [
          "titulo" => "Highlights"
          "clase" => "author-highlights"
          "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><p id="spara009" class="elsevierStyleSimplePara elsevierViewall"><ul class="elsevierStyleList" id="celist0001"><li class="elsevierStyleListItem" id="celistitem0001"><span class="elsevierStyleLabel">&#8226;</span><p id="para0001" class="elsevierStylePara elsevierViewall">Melatonin &#40;MT&#41; plays a similar role in ovarian damage as 3-MA does&#46;</p></li><li class="elsevierStyleListItem" id="celistitem0002"><span class="elsevierStyleLabel">&#8226;</span><p id="para0002" class="elsevierStylePara elsevierViewall">MT confers protection against ovarian damage <span class="elsevierStyleItalic">in vivo</span> and <span class="elsevierStyleItalic">in vitro</span>&#46;</p></li><li class="elsevierStyleListItem" id="celistitem0003"><span class="elsevierStyleLabel">&#8226;</span><p id="para0003" class="elsevierStylePara elsevierViewall">MT exerts its protective effects by inhibiting the PI3K&#47;AKT&#47;mTOR signaling pathway&#46;</p></li></ul></p></span>"
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222033208?idApp=UINPBA00004N"
    "url" => "/18075932/000000770000000C/v3_202308251443/S1807593222033208/v3_202308251443/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S1807593222033105"
    "issn" => "18075932"
    "doi" => "10.1016/j.clinsp.2022.100109"
    "estado" => "S300"
    "fechaPublicacion" => "2022-01-01"
    "aid" => "100109"
    "copyright" => "HCFMUSP"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Clinics. 2022;77C:"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original articles</span>"
      "titulo" => "COVID-19 post-vaccination in healthcare workers and vaccine effectiveness&#44; Brazil&#44; 2021"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "en"
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0001"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1438
              "Ancho" => 2500
              "Tamanyo" => 194829
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "alt0001"
              "detalle" => "Fig "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Distribution of confirmed cases of COVID-19 in HC healthcare workers according to epidemiological week of symptoms onset&#44; from March to August 2021&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Caio Medeiros Fernandes, Shirley L&#46; Dias, Maira C&#46; Ferreira, Expedito J&#46;A&#46; Luna"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Caio Medeiros"
              "apellidos" => "Fernandes"
            ]
            1 => array:2 [
              "nombre" => "Shirley L&#46;"
              "apellidos" => "Dias"
            ]
            2 => array:2 [
              "nombre" => "Maira C&#46;"
              "apellidos" => "Ferreira"
            ]
            3 => array:2 [
              "nombre" => "Expedito J&#46;A&#46;"
              "apellidos" => "Luna"
            ]
          ]
        ]
      ]
      "resumen" => array:1 [
        0 => array:3 [
          "titulo" => "Highlights"
          "clase" => "author-highlights"
          "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><p id="spara015" class="elsevierStyleSimplePara elsevierViewall"><ul class="elsevierStyleList" id="celist0001"><li class="elsevierStyleListItem" id="celistitem0001"><span class="elsevierStyleLabel">&#8226;</span><p id="para0001" class="elsevierStylePara elsevierViewall">Vaccination with any vaccine was effective in preventing confirmed COVID-19 cases&#46;</p></li><li class="elsevierStyleListItem" id="celistitem0002"><span class="elsevierStyleLabel">&#8226;</span><p id="para0002" class="elsevierStylePara elsevierViewall">CoronaVac was effective in preventing COVID-19 related hospitalizations&#46;</p></li><li class="elsevierStyleListItem" id="celistitem0003"><span class="elsevierStyleLabel">&#8226;</span><p id="para0003" class="elsevierStylePara elsevierViewall">Vaccination had a significant impact in reducing cases and hospitalizations&#46;</p></li><li class="elsevierStyleListItem" id="celistitem0004"><span class="elsevierStyleLabel">&#8226;</span><p id="para0004" class="elsevierStylePara elsevierViewall">Predominance of mild cases&#44; with respiratory symptoms&#44; myalgia&#44; and headache&#46;</p></li><li class="elsevierStyleListItem" id="celistitem0005"><span class="elsevierStyleLabel">&#8226;</span><p id="para0005" class="elsevierStylePara elsevierViewall">Vaccine protection waned over time&#46;</p></li></ul></p></span>"
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222033105?idApp=UINPBA00004N"
    "url" => "/18075932/000000770000000C/v3_202308251443/S1807593222033105/v3_202308251443/en/main.assets"
  ]
  "en" => array:17 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original articles</span>"
    "titulo" => "Seroconversion in asymptomatic COVID-19 pediatric patients with rheumatic diseases of one tertiary referral hospital"
    "tieneTextoCompleto" => true
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Juliana R&#46; Simon, Maria F&#46;B&#46; Pereira, Heloisa H&#46; Marques, Adriana M&#46; Elias, Neusa K&#46; Sakita, Juliana C&#46;O&#46;A&#46; Ferreira, Alexander Roberto Precioso, Sandra J&#46;F&#46;E&#46; Grisi, Ana Paula S&#46; Ferrer, Vera Bain, Clovis A&#46; Silva, L&#250;cia M&#46;A&#46; Campos"
        "autores" => array:12 [
          0 => array:4 [
            "nombre" => "Juliana R&#46;"
            "apellidos" => "Simon"
            "email" => array:1 [
              0 => "julianarussosimon@gmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0001"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0001"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Maria F&#46;B&#46;"
            "apellidos" => "Pereira"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0002"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Heloisa H&#46;"
            "apellidos" => "Marques"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0002"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Adriana M&#46;"
            "apellidos" => "Elias"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0001"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Neusa K&#46;"
            "apellidos" => "Sakita"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0004"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Juliana C&#46;O&#46;A&#46;"
            "apellidos" => "Ferreira"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0004"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Alexander Roberto"
            "apellidos" => "Precioso"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "aff0006"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Sandra J&#46;F&#46;E&#46;"
            "apellidos" => "Grisi"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">g</span>"
                "identificador" => "aff0007"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "Ana Paula S&#46;"
            "apellidos" => "Ferrer"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">g</span>"
                "identificador" => "aff0007"
              ]
            ]
          ]
          9 => array:3 [
            "nombre" => "Vera"
            "apellidos" => "Bain"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0002"
              ]
            ]
          ]
          10 => array:3 [
            "nombre" => "Clovis A&#46;"
            "apellidos" => "Silva"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0001"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0003"
              ]
            ]
          ]
          11 => array:3 [
            "nombre" => "L&#250;cia M&#46;A&#46;"
            "apellidos" => "Campos"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0001"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:7 [
          0 => array:3 [
            "entidad" => "Pediatric Rheumatology Unit&#44; Instituto da Crian&#231;a e do Adolescente&#44; Hospital das Cl&#237;nicas&#44; Faculdade de Medicina da Universidade de S&#227;o Paulo &#40;HCFMUSP&#41;&#44; S&#227;o Paulo&#44; SP&#44; Brazil"
            "etiqueta" => "a"
            "identificador" => "aff0001"
          ]
          1 => array:3 [
            "entidad" => "Pediatric Infectology Unit&#44; Instituto da Crian&#231;a e do Adolescente&#44; Hospital das Cl&#237;nicas&#44; Faculdade de Medicina da Universidade de S&#227;o Paulo &#40;HCFMUSP&#41;&#44; S&#227;o Paulo&#44; SP&#44; Brazil"
            "etiqueta" => "b"
            "identificador" => "aff0002"
          ]
          2 => array:3 [
            "entidad" => "Rheumatology Division&#44; Hospital das Cl&#237;nicas&#44; Faculdade de Medicina da Universidade de S&#227;o Paulo &#40;HCFMUSP&#41;&#44; S&#227;o Paulo&#44; SP&#44; Brazil"
            "etiqueta" => "c"
            "identificador" => "aff0003"
          ]
          3 => array:3 [
            "entidad" => "Clinical Research Center&#44; Instituto da Crian&#231;a e do Adolescente&#44; Hospital das Cl&#237;nicas&#44; Faculdade de Medicina da Universidade de S&#227;o Paulo &#40;HCFMUSP&#41;&#44; S&#227;o Paulo&#44; SP&#44; Brazil"
            "etiqueta" => "d"
            "identificador" => "aff0004"
          ]
          4 => array:3 [
            "entidad" => "Department of Infectious and Parasitic Diseases&#44; Faculdade de Medicina da Universidade de S&#227;o Paulo &#40;FMUSP&#41;&#44; S&#227;o Paulo&#44; SP&#44; Brazil"
            "etiqueta" => "e"
            "identificador" => "aff0005"
          ]
          5 => array:3 [
            "entidad" => "Division of Clinical Trials and Pharmacovigilance&#44; Instituto Butantan&#44; S&#227;o Paulo&#44; SP&#44; Brazil"
            "etiqueta" => "f"
            "identificador" => "aff0006"
          ]
          6 => array:3 [
            "entidad" => "Instituto da Crian&#231;a e do Adolescente&#44; Hospital das Cl&#237;nicas&#44; Faculdade de Medicina da Universidade de S&#227;o Paulo &#40;HCFMUSP&#41;&#44; S&#227;o Paulo&#44; SP&#44; Brazil"
            "etiqueta" => "g"
            "identificador" => "aff0007"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0001"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0008">Introduction</span><p id="para0008" class="elsevierStylePara elsevierViewall">The Coronavirus Disease-19 &#40;COVID-19&#41; is caused by the virus named Severe Acute Respiratory Syndrome Coronavirus-2 &#40;SARS-CoV-2&#41;&#44; initially described in the province of Wuhan&#44; China&#44; in December&#160;2019&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> It is recognized as one of the biggest pandemics the world has ever seen and caused more than&#160;670&#160;thousand deaths only in Brazil and more than&#160;6&#46;4&#160;million deaths worldwide until August&#160;2022&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a></p><p id="para0009" class="elsevierStylePara elsevierViewall">The disease is responsible for mild to moderate presentation in approximately&#160;80&#37; of people&#44; and&#160;20&#37; of adults progress to severe disease and require hospitalization&#44; with a mortality rate ranging from&#160;0&#46;5&#37;&#160;to&#160;4&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0003"><span class="elsevierStyleSup">3-5</span></a> Asymptomatic infections are described&#44; but the percentage is difficult to estimate since these patients often do not seek medical attention&#46; A systematic review showed wide variation between different studies&#44; ranging from&#160;1&#37;&#160;to&#160;50&#37; of cases&#46;<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a></p><p id="para0010" class="elsevierStylePara elsevierViewall">As the virus spread around the world throughout&#160;2020&#44; questions concerning the behavior of the infection in immunocompromised patients have arisen&#46; Several studies and cohorts with adult populations were carried out over the last year showing that patients with pediatric Autoimmune Rheumatic Diseases &#40;ARDs&#41; were more likely to be infected and to develop more severe forms of COVID-19&#44;<a class="elsevierStyleCrossRefs" href="#bib0006"><span class="elsevierStyleSup">6-11</span></a> since they present immunosuppressive mechanisms inherent to the disease itself and to its treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> In fact&#44; the use of corticosteroids and Disease-Modifying Antirheumatic Drugs &#40;DMARDs&#41; were identified as risk factors for more aggressive diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0008"><span class="elsevierStyleSup">8-11</span></a></p><p id="para0011" class="elsevierStylePara elsevierViewall">Since the beginning of the pandemic&#44; some studies suggested that healthy children could have a more indolent course of COVID-19&#46;<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a> Immunosuppressed children have not been as extensively studied as adults in the same condition&#46; Few studies have been published showing that children with chronic immunosuppressive diseases had symptomatic COVID-19 at the same rate and severity as healthy controls&#46;<a class="elsevierStyleCrossRefs" href="#bib0014"><span class="elsevierStyleSup">14-16</span></a> The present group has already published our experience with pediatric patients with ARDs and symptomatic COVID-19&#44; demonstrating that it affected just&#160;2&#37; of the population&#44; with mild to moderate manifestations&#46;<a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> Based on previous studies in healthy children and in pediatric immunosuppressed populations&#46;<a class="elsevierStyleCrossRefs" href="#bib0012"><span class="elsevierStyleSup">12-17</span></a> The authors hypothesized that children with ARDs&#44; regardless of the use of immunosuppressors&#44; are infected by COVID-19 similarly to the healthy ones&#44; considering that demographic characteristics may be the more determinant factor in contagion&#46;</p><p id="para0012" class="elsevierStylePara elsevierViewall">To our knowledge&#44; there are no studies on asymptomatic or oligosymptomatic COVID-19 in children with ARDs and there are several unanswered questions surrounding this subject&#46;</p><p id="para0013" class="elsevierStylePara elsevierViewall">Therefore&#44; the objectives of the present study are to evaluate seroconversion of asymptomatic SARS-CoV-2 infection in pediatric ARDs patients and healthy controls&#44; and to identify the risk factors related to contagion in this population&#46;</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0009">Methods</span><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0010">Study population</span><p id="para0014" class="elsevierStylePara elsevierViewall">This is a cross-sectional study performed with patients followed at the Pediatric Rheumatology Unit of a Brazilian tertiary hospital&#44; located in the city of S&#227;o Paulo&#44; conducted between March&#160;1<span class="elsevierStyleSup">st</span> to March&#160;31<span class="elsevierStyleSup">st</span>&#44; 2021&#44; before starting the vaccination of children and adolescents in Brazil&#46; Ninety-two patients with ARDs who attended the outpatient clinic or were in the hospital for other procedures in this period were invited to participate&#46; Four of them declined to participate in the study&#44; totaling&#160;88&#160;patients&#46; It included patients with Juvenile Idiopathic Arthritis &#40;JIA&#41;&#44; Juvenile Systemic Lupus Erythematosus &#40;JSLE&#41;&#44; Juvenile Dermatomyositis &#40;JDM&#41;&#44; scleroderma&#44; Mixed Connective Tissue Disease &#40;MCTD&#41;&#44; vasculitis &#40;Beh&#231;et disease and IgA Vasculitis&#41; and IgG4 disease&#46; The authors also invited&#160;56&#160;healthy children and adolescents to the control group&#44; who were patients&#39; family members or patients&#180; close friends and hospital staffs&#39; children&#59; they were invited to participate in the study by telephone or when they accompanied their relatives to outpatient consultations&#44; and ten of them refused to participate in the study&#44; totalizing&#160;46&#160;controls&#46;</p><p id="para0015" class="elsevierStylePara elsevierViewall">The study included subjects between one to&#160;18&#160;years old who did not have a previous diagnosis of COVID-19 by Reverse Transcription Polymerase Chain Reaction &#40;RT-PCR&#41; or serology over the last year and did not present signs or symptoms of COVID-19 strong enough to alert them for the possibility of the disease or to led them to seek for medical attention&#44; such as persistent fever&#44; flu-like syndrome&#44; prostration&#44; dyspnea&#44; intense cough&#44; persistent chest pain or pressure&#44; severe myalgia&#44; abdominal pain&#44; diarrhea&#44; mental confusion&#44; anosmia or dysgeusia&#46;<a class="elsevierStyleCrossRefs" href="#bib0018"><span class="elsevierStyleSup">18-20</span></a></p><p id="para0016" class="elsevierStylePara elsevierViewall">Children under one year of age were excluded due to the possibility of having circulating maternal antibodies&#44; and above&#160;19&#160;years old&#44; who are already considered adults according to the World Health Organization &#40;WHO&#41; criteria&#46;<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a> People who had shown warning signs for COVID-19 or who had been diagnosed with the disease in the previous year were excluded&#44; as well as subjects who had signs of active infection on the day of sample collection&#46; Patients who received Rituximab &#40;RTX&#41; or Intravenous Immunoglobulin &#40;IVIG&#41; in the six months prior to the study were also excluded since these medications could interfere with adequate antibody identification&#46;<a class="elsevierStyleCrossRefs" href="#bib0022"><span class="elsevierStyleSup">22-24</span></a></p><p id="para0017" class="elsevierStylePara elsevierViewall">All participant&#39;s guardians and the subjects above nine years old signed the consent form and assent form&#44; respectively&#46; The study was approved by the National Research and Ethics Committee &#40;approval number&#160;4&#46;558&#46;660&#41;&#46;</p></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0011">Questionnaire</span><p id="para0018" class="elsevierStylePara elsevierViewall">Patients and controls answered a questionnaire with demographic data &#40;age&#44; gender&#44; family income&#44; years of maternal education&#44; number of inhabitants in the residence&#41;&#44; previous pathologies&#44; symptoms compatible with COVID-19 over the past&#160;12&#160;months and date of occurrence&#44; contact with people with confirmed COVID-19 &#40;as well as the place where it occurred&#41;&#44; and contact with other immunosuppressed people in the residence&#46; Patient&#39;s medical records were reviewed to obtain data regarding the disease&#44; current medications&#44; their doses &#40;hydroxychloroquine and immunosuppressants agents&#44; such as corticosteroids&#44; DMARDS&#44; cytotoxic and immunomodulatory agents and biological medications&#41;&#44; and whether they received RTX or IVIG in the last six months&#46;</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0012">Laboratory analysis</span><p id="para0019" class="elsevierStylePara elsevierViewall">A sample of&#160;3&#160;to&#160;5&#160;mL of peripheral blood was collected from each enrolled participant&#46; The sample was centrifuged and kept under refrigeration &#40;2&#176; to&#160;8&#176;C&#41; for a maximum period of three days&#46; An immunochromatographic qualitative serological test &#40;Wondfo&#174;&#41;&#44; which analyzes total &#40;IgG and IgM&#41; antibodies for SARS-CoV-2&#44; was performed for all study subjects&#44; with a sensitivity of&#160;86&#46;43&#37; &#40;95&#37;&#160;CI&#160;82&#46;41&#37; &#8764; 89&#46;58&#37;&#41; and specificity of&#160;99&#46;57&#37; &#40;95&#37;&#160;CI&#160;97&#46;63&#37; &#8764; 99&#44;92&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">25-27</span></a> The test was considered valid if a colored test band appeared in the control region &#40;C&#41; and positive if a colored line appeared in the test region &#40;T&#41; within&#160;15&#160;minutes of starting the reaction&#46;<a class="elsevierStyleCrossRef" href="#bib0026"><span class="elsevierStyleSup">26</span></a></p></span><span id="sec0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0013">Statistic analysis</span><p id="para0020" class="elsevierStylePara elsevierViewall">Data was recorded in the Microsoft Excel spreadsheet program and analyzed using MedCalc software version&#160;17&#46;8&#46;6 and GraphPad StatMate version&#160;1&#46;01&#46; Categorical variables are presented as frequencies and percentages&#46; Fisher&#39;s exact test or Pearson&#39;s Chi-Square test were used to comparing these variables&#46; The results of continuous variables were expressed as median &#40;range&#41; or mean &#40;&#177;standard deviation&#41; and compared by Mann-Whitney and Student&#39;s <span class="elsevierStyleItalic">t</span>-tests&#44; as appropriate&#59; p-values below&#160;0&#46;05 were considered significant&#46;</p></span></span><span id="sec0007" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0014">Results</span><p id="para0021" class="elsevierStylePara elsevierViewall">134&#160;subjects were eligible to participate in the study&#44; comprising&#160;88&#160;patients and&#160;46&#160;controls&#46; Among patients&#44; seven were excluded due to diagnosis of COVID-19 over the past&#160;12&#160;months and four patients for receiving RTX or IVIG in the past six months&#44; resulting in&#160;77&#160;enrolled patients&#46; In the control group&#44; only one child was excluded for a confirmed previous diagnosis of COVID-19&#46; The final control group consisted of&#160;18&#160;&#40;40&#37;&#41; relatives of employees&#44; 26&#160;&#40;57&#46;8&#37;&#41; relatives&#44; and 1&#160;close friend of the participating patients&#46;</p><p id="para0022" class="elsevierStylePara elsevierViewall">The patients&#8217; group included&#160;31&#160;&#40;40&#46;2&#37;&#41; JIA patients&#44; 25&#160;&#40;32&#46;4&#37;&#41; JSLE&#44; 11&#160;&#40;14&#46;3&#37;&#41; JDM&#44; six patients with vasculitis&#44; two with SS&#44; one MCTD&#44; and one IgG4 disease&#46; For statistical convenience&#44; the last four groups of patients were joined into a single group called Other Pathologies &#40;OP&#41; and represented 13&#37;&#160;&#40;10&#47;77&#41; of all patients&#46;</p><p id="para0023" class="elsevierStylePara elsevierViewall">Serology was positive in&#160;17&#160;&#40;22&#37;&#41; patients and 7&#160;&#40;15&#46;5&#37;&#41; controls&#44; without a difference between the groups &#40;p&#160;&#61;&#160;0&#46;481&#41;&#46; Groups were comparable in female gender &#40;70&#46;1&#37;&#160;vs&#46;&#160;57&#46;8&#37;&#44; p&#160;&#61;&#160;0&#46;173&#41; and median current age &#40;14&#160;vs&#46;&#160;13&#160;years&#44; p&#160;&#61;&#160;0&#46;269&#41;&#46; Regarding socioeconomic data&#44; the patient&#39;s median family income was significantly lower compared to controls &#40;2&#46;5&#160;vs&#46;&#160;5&#160;minimum wages&#44; p &#60; 0&#46;001&#41;&#44; as well as lower median years of maternal education &#40;11&#160;vs&#46;&#160;14&#160;years&#44; p&#160;&#61;&#160;0&#46;002&#41;&#44; and lower contact with other immunocompromised people at residence &#40;13&#37;&#160;vs&#46;&#160;31&#46;1&#37;&#44; p&#160;&#61;&#160;0&#46;019&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>&#41;&#46; No statistical differences were seen between the groups related to the number of inhabitants in the residence and frequency of contact with COVID-19&#46; These contacts occurred most frequently in their own residences in both patients and controls &#40;76&#46;5&#37;&#160;vs&#46;&#160;88&#46;2&#37;&#44; p&#160;&#61;&#160;0&#46;656&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0001"></elsevierMultimedia><p id="para0024" class="elsevierStylePara elsevierViewall">Among patients with ARDs&#44; 10&#47;77&#160;&#40;13&#37;&#41; weren&#39;t receiving treatment for baseline disease&#59; 62&#47;77&#160;&#40;80&#46;5&#37;&#41; were in use of immunosuppressive drugs &#40;biological and non-biological&#41;&#44; 38&#46;7&#37;&#160;&#40;24&#47;62&#41; of them were taking a single immunosuppressive agent&#44; 51&#46;6&#37;&#160;&#40;32&#47;62&#41; two agents and 9&#46;6&#37;&#160;&#40;6&#47;62&#41; three or more immunosuppressive drugs&#46; Regarding the use of corticosteroids&#44; 21&#47;77&#160;&#40;27&#46;3&#37;&#41; patients were using corticosteroids at the time of collection&#44; and 33&#46;3&#37; of them &#40;7&#47;21&#41; were using it in high doses &#40;&#8805; 20&#160;mg&#47;day or &#8805; 1&#160;mg&#47;kg&#47;day&#41;&#46; Among the immunosuppressive agents used&#44; 26&#160;patients were using Methotrexate&#44; nine Leflunomide&#44; seven Azathioprine&#44; four cyclophosphamide&#44; three Cyclosporine&#44; two Sulfasalazine&#44; and one Tacrolimus&#46; Six out of&#160;77&#160;&#40;7&#46;8&#37;&#41; patients were in the use of immunobiological &#40;adalimumab in three patients&#44; etanercept in two&#44; and tocilizumab in one&#41;&#46; Hydroxychloroquine was in use by&#160;30&#47;77&#160;&#40;39&#37;&#41; of all patients&#46;</p><p id="para0025" class="elsevierStylePara elsevierViewall">Patients were divided according to serology results&#58; 17&#160;&#40;22&#37;&#41; were positive and 60&#160;&#40;77&#46;9&#37;&#41; were negative &#40;<a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>&#41;&#46; These groups were compared regarding demographic and socioeconomic data&#44; and no statistical differences were found in gender&#44; age&#44; family income&#44; number of inhabitants in the residence&#44; and maternal education&#44; as well as in relation to contact with people with confirmed COVID-19 or with other immunocompromised people&#46; Concerning treatment&#44; the groups were similar in terms of the use of hydroxychloroquine and the use and number of immunosuppressive drugs &#40;biological and non-biological&#41;&#46; Further analysis showed that the groups were also similar regarding the use and dose of corticosteroids and use of immunobiological drugs &#40;p&#62;0&#46;05&#41;&#46; No statistical significance was found between groups with respect to the distribution of different chronic conditions studied &#40;<a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0002"></elsevierMultimedia></span><span id="sec0008" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0015">Discussion</span><p id="para0026" class="elsevierStylePara elsevierViewall">As hypothesized&#44; the present study demonstrated that children with rheumatic diseases without warning signs for COVID-19 became infected at the same rate as the healthy population&#44; regardless of their immune status or treatment&#46;</p><p id="para0027" class="elsevierStylePara elsevierViewall">The impact of the SARS-CoV-2 pandemic on rheumatic populations is a point of great concern due to their immune status&#46; In fact&#44; studies that analyzed the virus epidemiology and its risk factors in adult rheumatic patients showed that this population presented an increased risk of SARS-CoV-2 infection&#44; especially if they used DMARDs&#46;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a> Additionally they are also more likely to have hospitalizations for COVID-19&#44; especially those using glucocorticoids&#46;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a></p><p id="para0028" class="elsevierStylePara elsevierViewall">However&#44; immunosuppressed pediatric populations seem to present a milder outcome&#46; In fact&#44; a study with&#160;113&#160;children and adolescents with kidney diseases with confirmed COVID-19<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a> showed that children&#44; even when using immunosuppressants&#44; did not present a higher incidence of severe cases of the disease&#46; In pediatric ARDs&#44; a previous study carried out by the Pediatric Rheumatology group demonstrated that symptomatic COVID-19 was found in just&#160;2&#37; of the present cases&#44; with the predominance of mild to moderate manifestations and none of them presented flare of their underlying pathology&#46;<a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a></p><p id="para0029" class="elsevierStylePara elsevierViewall">Moreover&#44; an American study conducted in a single center in Pennsylvania&#44; investigated the seroprevalence of SARS-CoV-2 in&#160;485&#160;immunocompromised children with various chronic conditions&#44; without systematic evaluation of demographic data or therapeutic characteristics and without analyses of asymptomatic cases&#44; and found&#160;that 1&#37; of infection in this population&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a> Although the present study has found a higher frequency of SARS-CoV-2 infection &#40;22&#37;&#41;&#44; the present results are in agreement with the serological survey carried out in the city of S&#227;o Paulo in 2020&#46;<a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a> This survey used the same immunochromatographic test as used herein&#44; and observed a prevalence of&#160;17&#46;6&#37; of positive serology in the general pediatric population&#46; As the authors previously assumed&#44; the present study did not find differences in the positivity of serology for SARS-CoV-2 in asymptomatic children and adolescents&#44; has been similar in those with rheumatic diseases as well as in healthy controls&#44; demonstrating that&#44; unlike adults&#44;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0028"><span class="elsevierStyleSup">28</span></a> indeed&#44; pediatric populations tend to have fewer symptoms of COVID-19<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a> even if they have immunosuppressive diseases or if in use of immunosuppressive drugs &#40;biological or non-biological&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a></p><p id="para0030" class="elsevierStylePara elsevierViewall">In the serological survey carried out in the city of S&#227;o Paulo throughout&#160;2020&#44; it was observed that adults were more likely to become infected when they had lower income and education&#44; and while living in houses with five or more inhabitants&#46;<a class="elsevierStyleCrossRef" href="#bib0029"><span class="elsevierStyleSup">29</span></a> In the present study&#44; the authors analyzed these data in patients and controls&#44; and&#44; even though the groups had some significant socio-economical differences&#44; such as family income and mothers&#39; education&#44; there was still no difference in the frequency of asymptomatic or oligosymptomatic cases&#46; It is important to emphasize that in most patients and controls the contact with a confirmed case of COVID-19 occurred within their own residences since their relatives still leave for work&#46; Regarding contact with immunocompromised people&#44; as was expected&#44; it was higher in the control group&#44; since most of them were patients&#8217; relatives&#46; This could be a bias of the study since it could be expected that&#44; under these conditions&#44; the research subject could be more rigorous regarding preventive measures to avoid COVID-19&#44; aiming to indirectly protect their family members&#46;</p><p id="para0031" class="elsevierStylePara elsevierViewall">Looking for possible differences in SARS-CoV-2 seroconversion among pediatric patients with ARDs&#44; the underlying disease did not represent a significant risk factor itself&#46; The same occurred regarding the use of immunosuppressive drugs&#44; independent of the number and dose of medications taken&#46; These observations demonstrate that&#44; regardless of the immunosuppression mechanism&#44; COVID-19 did not infect immunosuppressed children with ARDs more frequently&#44; once more highlighting the differences between pediatric and adult rheumatic populations&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a></p><p id="para0032" class="elsevierStylePara elsevierViewall">Otherwise&#44; Rituximab &#40;RTX&#41; inspires greater concern since this medication could reduce antibody production&#44; increasing the risk of more severe infectious events&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">30</span></a> Two studies with adult populations analyzing the use of RTX and SARS-CoV-2 infection found an association between the use of this medication and higher morbidity and mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0031"><span class="elsevierStyleSup">31</span></a> In the authors&#8217; previous study with&#160;14&#160;rheumatic patients with symptomatic COVID-19&#44; no serious involvement was seen&#44; but none of them was in the use of RTX&#46;<a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> After its publication&#44; the authors had a single JDM adolescent patient who had received RTX and died from COVID-19 one month after its infusion &#40;data not published&#41;&#46; In the present study&#44; the authors excluded patients who used RTX in the previous six months&#44; aiming to avoid the interference of this medication in test results&#46;</p><p id="para0033" class="elsevierStylePara elsevierViewall">Analyzing the use of hydroxychloroquine&#44; its use did not show efficacy in preventing COVID-19 since no differences were found between positive and negative patients related to the continuous use of this medication&#44; as shown in previous studies&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a></p><p id="para0034" class="elsevierStylePara elsevierViewall">One important limitation of this study is the small sample of patients&#46; The reason for this was the fact that the study was conducted during the second wave of COVID-19 in Brazil&#44; which was much stronger than the first one&#44; in&#160;2020&#46; As a result&#44; only patients who really needed in-person appointments attended the present study&#39;s outpatient clinics&#46; Even so&#44; this sample of patients represents&#160;12&#37; of the total number of patients seen at the rheumatology unit &#40;77&#47;638&#41;&#46; Also&#44; despite the size of the study&#44; it showed an important trend in the immunological behavior against COVID-19 in pediatric patients with ARDs&#46;</p><p id="para0035" class="elsevierStylePara elsevierViewall">Another limitation of the study is the size and selection of the control group&#44; which was also linked to the second wave of COVID since during this period the patients could come to the outpatient clinics accompanied only by their guardians&#46; So&#44; the final control group was composed of&#160;40&#37; of health workers&#39; relatives&#44; which may have contributed to an increased intra-household contagion&#46;</p><p id="para0036" class="elsevierStylePara elsevierViewall">In conclusion&#44; children and adolescents with ARDs were infected at the same rate as healthy ones&#46; Furthermore&#44; neither the underlying pathology nor its treatment seemed to interfere with the risk of contagion&#44; which occurred mostly within their own residences&#46; Larger and multicenter studies&#44; including analyses of new variants&#44; are needed to corroborate the present results&#46;</p></span><span id="sec0009" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0016">Authors&#39; contributions</span><p id="para0037" class="elsevierStylePara elsevierViewall">Juliana R Simon&#44; Clovis A Silva and Lucia M A Campos participated in the conception&#44; design of the work&#44; acquisition&#44; analysis&#44; interpretation of data&#44; and substantively revised the final text&#46; Maria F B Pereira and Heloisa H Marques participated in the conception&#44; design of the work&#44; acquisition&#44; and substantively revised the final text&#46; Vera Bain participated in the conception&#44; design of the work and acquisition of data&#46; Juliana COA Ferreira&#44; Neusa K Sakita&#44; had actively participated in the acquisition of data&#46; Adriana M Elias&#44; Alexandre R Precioso&#44; Sandra J F E Grisi&#44; Ana PSF Barreto substantively revised the manuscript&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:9 [
        0 => array:3 [
          "identificador" => "xres1953929"
          "titulo" => "Highlights"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abss0001"
            ]
          ]
        ]
        1 => array:3 [
          "identificador" => "xres1953930"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abss0003"
              "titulo" => "Objectives"
            ]
            1 => array:2 [
              "identificador" => "abss0004"
              "titulo" => "Methods"
            ]
            2 => array:2 [
              "identificador" => "abss0005"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abss0006"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        2 => array:2 [
          "identificador" => "xpalclavsec1682051"
          "titulo" => "Keywords"
        ]
        3 => array:2 [
          "identificador" => "sec0001"
          "titulo" => "Introduction"
        ]
        4 => array:3 [
          "identificador" => "sec0002"
          "titulo" => "Methods"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0003"
              "titulo" => "Study population"
            ]
            1 => array:2 [
              "identificador" => "sec0004"
              "titulo" => "Questionnaire"
            ]
            2 => array:2 [
              "identificador" => "sec0005"
              "titulo" => "Laboratory analysis"
            ]
            3 => array:2 [
              "identificador" => "sec0006"
              "titulo" => "Statistic analysis"
            ]
          ]
        ]
        5 => array:2 [
          "identificador" => "sec0007"
          "titulo" => "Results"
        ]
        6 => array:2 [
          "identificador" => "sec0008"
          "titulo" => "Discussion"
        ]
        7 => array:2 [
          "identificador" => "sec0009"
          "titulo" => "Authors&#39; contributions"
        ]
        8 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2022-05-23"
    "fechaAceptado" => "2022-08-29"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1682051"
          "palabras" => array:6 [
            0 => "COVID-19 testing"
            1 => "Rheumatic diseases"
            2 => "Immunosuppressive treatment"
            3 => "SARS-CoV-2"
            4 => "Serology"
            5 => "Children"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "highlights" => array:2 [
      "titulo" => "Highlights"
      "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><p id="spara005" class="elsevierStyleSimplePara elsevierViewall"><ul class="elsevierStyleList" id="celist0001"><li class="elsevierStyleListItem" id="celistitem0001"><span class="elsevierStyleLabel">&#8226;</span><p id="para0001" class="elsevierStylePara elsevierViewall">The study evaluated seroconverted asymptomatic COVID-19 in pediatric Autoimmune Rheumatic Diseases &#40;ARDs&#41; patients&#46;</p></li><li class="elsevierStyleListItem" id="celistitem0002"><span class="elsevierStyleLabel">&#8226;</span><p id="para0002" class="elsevierStylePara elsevierViewall">Pediatric rheumatic disease patients were infected at the same rate as healthy ones&#46;</p></li><li class="elsevierStyleListItem" id="celistitem0003"><span class="elsevierStyleLabel">&#8226;</span><p id="para0003" class="elsevierStylePara elsevierViewall">Neither the underlying pathology nor its immunosuppressive treatment seemed to interfere with contagion risk&#46;</p></li></ul></p></span>"
    ]
    "resumen" => array:1 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Objectives</span><p id="spara006" class="elsevierStyleSimplePara elsevierViewall">To evaluate seroconverted asymptomatic COVID-19 in pediatric Autoimmune Rheumatic Diseases &#40;ARDs&#41; patients and to identify the risk factors related to contagion&#46;</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Methods</span><p id="spara007" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional study was conducted in March&#160;2021&#44; before vaccination of children and adolescents in Brazil&#44; including&#160;77&#160;pediatric ARDs patients&#44; followed at a tertiary hospital and 45&#160;healthy controls&#44; all of them without a previous diagnosis of COVID-19&#46; Data was obtained by a questionnaire with demographic data&#44; symptoms compatible with COVID-19 over the previous year&#44; and contact with people with confirmed COVID-19&#46; Patient&#39;s medical records were reviewed to access data regarding disease and current medications&#46; A qualitative immunochromatographic SARS-CoV-2 test was performed on all participants&#46;</p></span> <span id="abss0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Results</span><p id="spara008" class="elsevierStyleSimplePara elsevierViewall">Patients and controls were similar in terms of female gender &#40;70&#46;1&#37;&#160;vs&#46;&#160;57&#46;8&#37;&#44; p&#160;&#61;&#160;0&#46;173&#41;&#44; age &#40;14&#160;vs&#46;&#160;13 years&#44; p&#160;&#61;&#160;0&#46;269&#41; and SARS-CoV-2 positive serology &#40;22&#37;&#160;vs&#46;&#160;15&#46;5&#37;&#44; p&#160;&#61;&#160;0&#46;481&#41;&#46; 80&#46;5&#37; of rheumatic patients were in use of immunosuppressive drugs&#58;&#160;27&#46;3&#37; of them used corticosteroids &#40;33&#46;3&#37;&#160;in high doses&#41;&#44; and 7&#46;8&#37;&#160;on immunobiologicals&#46; No statistical differences were found between positive &#40;n&#160;&#61;&#160;17&#41; and negative serology &#40;n&#160;&#61;&#160;60&#41; patients regarding demographic&#47;socioeconomic data&#44; contact with people with confirmed COVID-19&#44; use and number of immunosuppressive drugs&#44; use and dose of corticosteroids&#44; use of hydroxychloroquine and immunobiological drugs &#40;p &#62; 0&#46;05&#41;&#46;</p></span> <span id="abss0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0006">Conclusions</span><p id="spara009" class="elsevierStyleSimplePara elsevierViewall">Pediatric rheumatic disease patients were infected at the same rate as healthy ones&#46; Neither the underlying pathology nor its immunosuppressive treatment seemed to interfere with contagion risk&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abss0003"
            "titulo" => "Objectives"
          ]
          1 => array:2 [
            "identificador" => "abss0004"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abss0005"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abss0006"
            "titulo" => "Conclusions"
          ]
        ]
      ]
    ]
    "multimedia" => array:2 [
      0 => array:8 [
        "identificador" => "tbl0001"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0001"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spara002" class="elsevierStyleSimplePara elsevierViewall">Results presented in frequency &#40;&#37;&#41; and median &#40;range&#41;&#46; p-values &#60; 0&#46;05 were considered as significant&#46; SARS-CoV-2&#44; Severe Acute Respiratory Syndrome Coronavirus 2&#59; COVID-19&#44; Disease of Coronavirus-19&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0001"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0002"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Patients &#40;n&#160;&#61;&#160;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0003"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Controls &#40;n&#160;&#61;&#160;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0004"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">p-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0005"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Female gender&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0006"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">54 &#40;70&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0007"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">26 &#40;57&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0008"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;173&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0009"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Current age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0010"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">14 &#40;4&#8210;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0011"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">13 &#40;10&#8210;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0012"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;269&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0013"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Family income &#40;minimum wages&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0014"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;5 &#40;0&#8210;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0015"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">5 &#40;1&#8210;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0016"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#60; 0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0017"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Number of inhabitants in the residence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0018"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4 &#40;2&#8210;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0019"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4 &#40;2&#8210;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0020"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;335&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0021"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Maternal education &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0022"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">11 &#40;3&#8210;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0023"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">14 &#40;3&#8210;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0024"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0025"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Contact with SARS-CoV-2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0026"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">17 &#40;22&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0027"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">17 &#40;37&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0028"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;093&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0029"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Contact with COVID-19 at home&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0030"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">13&#47;17 &#40;76&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0031"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">15&#47;17 &#40;88&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0032"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;656&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0033"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Contact with immunocompromised people&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0034"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">10 &#40;13&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0035"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">14 &#40;31&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0036"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0037"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Positive serology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0038"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">17 &#40;22&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0039"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">7 &#40;15&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0040"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;481&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3252547.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Demographic and socioeconomic data and serological test in pediatric rheumatic patients <span class="elsevierStyleItalic">vs</span>&#46; controls&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0002"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0002"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spara004" class="elsevierStyleSimplePara elsevierViewall">Results presented in frequency &#40;&#37;&#41; and median &#40;range&#41;&#46; p-values&#160;&#60; 0&#46;05 were considered as significant&#46; SARS-CoV-2&#46; Severe Acute Respiratory Syndrome Coronavirus&#160;2&#44; JIA&#44; Juvenile Idiopathic Arthritis&#44; JSLE&#44; Juvenile Systemic Lupus Erythematosus&#59; JDM&#44; Juvenile dermatomyositis&#59; NA&#44; Not Applicable&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0041"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0042"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Positive serology&#40;n&#160;&#61;&#160;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0043"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Negative serology&#40;n&#160;&#61;&#160;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0044"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">p-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0045"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Female gender</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0046"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">13 &#40;76&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0047"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">41 &#40;68&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0048"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;764&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0049"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Current age &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0050"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">15 &#40;4&#8210;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0051"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">14 &#40;4&#8210;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0052"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;888&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0053"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Family income &#40;minimum wages&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0054"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2 &#40;0&#8210;5&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0055"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;5 &#40;0&#46;3&#8210;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0056"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;210&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0057"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Number of inhabitants in the residence</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0058"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4 &#40;2&#8210;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0059"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4 &#40;2&#8210;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0060"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;589&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0061"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Maternal education &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0062"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">11 &#40;3&#8210;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0063"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">11 &#40;5&#8210;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0064"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;076&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0065"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Contact with SARS-CoV-2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0066"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">5 &#40;29&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0067"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">12 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0068"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;508&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0069"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Contact with immunocompromised people</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0070"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3 &#40;17&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0071"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">7 &#40;11&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0072"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;682&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0073"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Use of hydroxychloroquine</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0074"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">8 &#40;47&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0075"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">22 &#40;36&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0076"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;574&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0077"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Use of immunosuppressors</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0078"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">15 &#40;88&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0079"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">47 &#40;78&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0080"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;298&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0081"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Number of immunosuppressors</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0082"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0083"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0084"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;468&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0085"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">n&#160;&#61;&#160;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0086"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">8 &#40;33&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0087"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">16 &#40;66&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0088"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0089"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">n&#160;&#61;&#160;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0090"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">6 &#40;18&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0091"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">26 &#40;81&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0092"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0093"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">n&#160;&#61;&#160;3 or &#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0094"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1 &#40;16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0095"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">5 &#40;83&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0096"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0097"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Use of corticosteroids</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0098"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3 &#40;17&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0099"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">18 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0100"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;373&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0101"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Dose of corticosteroids</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0102"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0103"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0104"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0105"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Median dose &#40;mg&#47;kg&#47;dia&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0106"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;55 &#40;0&#46;15&#8210;0&#46;68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0107"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;21 &#40;0&#46;05&#8210;2&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0108"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;525&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0109"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">High dose &#40;&#8805; 20&#160;mg&#47;day or &#8805; 1&#160;mg&#47;kg&#47;day&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0110"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2 &#40;11&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0111"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">5 &#40;8&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0112"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;646&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0113"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Use of immunobiological drugs</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0114"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1 &#40;5&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0115"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">5 &#40;8&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0116"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0117"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Pathology</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0118"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0119"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0120"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;564&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0121"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">JIA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0122"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">6 &#40;19&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0123"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">25 &#40;80&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0124"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0125"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">JSLE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0126"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">8 &#40;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0127"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">17 &#40;68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0128"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0129"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">JDM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0130"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3 &#40;27&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0131"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">8 &#40;72&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0132"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0133"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Others&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0134"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0135"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">10 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0136"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3252548.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara003" class="elsevierStyleSimplePara elsevierViewall">Demographic and socioeconomic data&#44; use of immunosuppressive drugs and underlying pathology in pediatric rheumatic patients according to serological test results&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "cebibsec1"
          "bibliografiaReferencia" => array:31 [
            0 => array:3 [
              "identificador" => "bib0001"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A novel coronavirus outbreak of global health concern"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C Wang"
                            1 => "PW Horby"
                            2 => "FG Hayden"
                            3 => "GF&#46; Gao"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(20)30185-9"
                      "Revista" => array:7 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2020"
                        "volumen" => "395"
                        "numero" => "10223"
                        "paginaInicial" => "470"
                        "paginaFinal" => "473"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31986257"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0002"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "University JH&#46; COVID-19 Map &#8210; Johns Hopkins Coronavirus Resource Center&#58; &#64;JohnsHopkins&#59; 2021 &#46; Available from&#58; <a target="_blank" href="https://coronavirus.jhu.edu/map.html">https&#58;&#47;&#47;coronavirus&#46;jhu&#46;edu&#47;map&#46;html</a>&#46; Accessed on August 02nd&#44; 2022&#46;"
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0003"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Characteristics of and important lessons from the coronavirus disease 2019 &#40;COVID-19&#41; outbreak in China&#58; summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Z Wu"
                            1 => "JM&#46; McGoogan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.2020.2648"
                      "Revista" => array:7 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2020"
                        "volumen" => "323"
                        "numero" => "13"
                        "paginaInicial" => "1239"
                        "paginaFinal" => "1242"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32091533"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0004"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence and severity of corona virus disease 2019 &#40;COVID-19&#41;&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Y Hu"
                            1 => "J Sun"
                            2 => "Z Dai"
                            3 => "H Deng"
                            4 => "X Li"
                            5 => "Q Huang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "J Clin Virol"
                        "fecha" => "2020"
                        "volumen" => "127"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The many estimates of the COVID-19 case fatality rate"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "DD Rajgor"
                            1 => "MH Lee"
                            2 => "S Archuleta"
                            3 => "N Bagdasarian"
                            4 => "SC&#46; Quek"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S1473-3099(20)30244-9"
                      "Revista" => array:7 [
                        "tituloSerie" => "Lancet Infect Dis"
                        "fecha" => "2020"
                        "volumen" => "20"
                        "numero" => "7"
                        "paginaInicial" => "776"
                        "paginaFinal" => "777"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32224313"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0006"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A systematic review of asymptomatic infections with COVID-19"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Z Gao"
                            1 => "Y Xu"
                            2 => "C Sun"
                            3 => "X Wang"
                            4 => "Y Guo"
                            5 => "S Qiu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jmii.2020.05.001"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Microbiol Immunol Infect"
                        "fecha" => "2021"
                        "volumen" => "54"
                        "numero" => "1"
                        "paginaInicial" => "12"
                        "paginaFinal" => "16"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32425996"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0007"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Poor prognosis of COVID-19 acute respiratory distress syndrome in lupus erythematosus&#58; nationwide cross-sectional population study of 252 119 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "IM Bertoglio"
                            1 => "JML Valim"
                            2 => "D Daffre"
                            3 => "NE Aikawa"
                            4 => "CA Silva"
                            5 => "E Bonf&#225;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/acr2.11329"
                      "Revista" => array:7 [
                        "tituloSerie" => "ACR Open Rheumatol"
                        "fecha" => "2021"
                        "volumen" => "3"
                        "numero" => "11"
                        "paginaInicial" => "804"
                        "paginaFinal" => "811"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34423922"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0008"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "COVID-19 Global Rheumatology Alliance&#46; Characteristics associated with hospitalization for COVID-19 in people with rheumatic disease&#58; data from the COVID-19 Global Rheumatology Alliance physician-reported registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M Gianfrancesco"
                            1 => "KL Hyrich"
                            2 => "S Al-Adely"
                            3 => "L Carmona"
                            4 => "MI Danila"
                            5 => "L Gossec"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/annrheumdis-2020-217871"
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2020"
                        "volumen" => "79"
                        "numero" => "7"
                        "paginaInicial" => "859"
                        "paginaFinal" => "866"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32471903"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0009"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases treated with rituximab&#58; a cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J Avouac"
                            1 => "E Drumez"
                            2 => "E Hachulla"
                            3 => "R Seror"
                            4 => "S Georgin-Lavialle"
                            5 => "S El Mahou"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S2665-9913(21)00059-X"
                      "Revista" => array:7 [
                        "tituloSerie" => "Lancet Rheumatol"
                        "fecha" => "2021"
                        "volumen" => "3"
                        "numero" => "6"
                        "paginaInicial" => "e419"
                        "paginaFinal" => "e426"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33786454"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical course&#44; and outcomes of COVID-19 in rheumatic disease patients&#58; a case cohort study with a diverse population"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "T Arleo"
                            1 => "D Tong"
                            2 => "J Shabto"
                            3 => "G O&#39;Keefe"
                            4 => "A&#46; Khosroshahi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10067-021-05578-x"
                      "Revista" => array:7 [
                        "tituloSerie" => "Clin Rheumatol"
                        "fecha" => "2021"
                        "volumen" => "40"
                        "numero" => "7"
                        "paginaInicial" => "2633"
                        "paginaFinal" => "2642"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33420870"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0011"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rheumatic disease and COVID-19&#58; epidemiology and outcomes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H KL"
                            1 => "M PM"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/s41584-020-00562-2"
                      "Revista" => array:8 [
                        "tituloSerie" => "Nat Rev Rheumatol"
                        "fecha" => "2021"
                        "volumen" => "17"
                        "numero" => "2"
                        "paginaInicial" => "71"
                        "paginaFinal" => "72"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33339986"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109798002848"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0012"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical characteristics of COVID-19 in children&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J Yasuhara"
                            1 => "T Kuno"
                            2 => "H Takagi"
                            3 => "N&#46; Sumitomo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ppul.24991"
                      "Revista" => array:7 [
                        "tituloSerie" => "Pediatr Pulmonol"
                        "fecha" => "2020"
                        "volumen" => "55"
                        "numero" => "10"
                        "paginaInicial" => "2565"
                        "paginaFinal" => "2575"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32725955"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0013"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "JF&#46; Ludvigsson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/apa.15270"
                      "Revista" => array:7 [
                        "tituloSerie" => "Acta Paediatr"
                        "fecha" => "2020"
                        "volumen" => "109"
                        "numero" => "6"
                        "paginaInicial" => "1088"
                        "paginaFinal" => "1095"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32202343"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0014"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "COVID-19 in children treated with immunosuppressive medication for kidney diseases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M Marlais"
                            1 => "T Wlodkowski"
                            2 => "S Al-Akash"
                            3 => "P Ananin"
                            4 => "VK Bandi"
                            5 => "V Baudouin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/archdischild-2020-320616"
                      "Revista" => array:7 [
                        "tituloSerie" => "Arch Dis Child"
                        "fecha" => "2021"
                        "volumen" => "106"
                        "numero" => "8"
                        "paginaInicial" => "798"
                        "paginaFinal" => "801"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33355203"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Immunocompromised seroprevalence and course of illness of SARS-CoV-2 in one pediatric quaternary care center"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "MC Freeman"
                            1 => "GJ Rapsinski"
                            2 => "ML Zilla"
                            3 => "SE&#46; Wheeler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/jpids/piaa123"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Pediatric Infect Dis Soc"
                        "fecha" => "2021"
                        "volumen" => "10"
                        "numero" => "4"
                        "paginaInicial" => "426"
                        "paginaFinal" => "431"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33049042"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0016"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Inqu&#233;rito sorol&#243;gico para SARS-COV-2&#58; preval&#234;ncia da infec&#231;&#227;o em escolares das redes p&#250;blica e privada da cidade de S&#227;o Paulo - resultado final fases 1 a 4 2020 &#91;updated October 13&#44; 2020 July 1&#44; 2021&#93;&#46; Available from&#58; <a target="_blank" href="https://www.prefeitura.sp.gov.br/cidade/secretarias/upload/saude/2020_10_13_inq_soro_escolares_fase1_4.pdf">https&#58;&#47;&#47;www&#46;prefeitura&#46;sp&#46;gov&#46;br&#47;cidade&#47;secretarias&#47;upload&#47;saude&#47;2020&#95;10&#95;13&#95;inq&#95;soro&#95;escolares&#95;fase1&#95;4&#46;pdf</a>&#46;"
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0017"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Laboratory-confirmed pediatric COVID-19 in patients with rheumatic diseases&#58; a case series in a tertiary hospital"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "BP Ihara"
                            1 => "CA Strabelli"
                            2 => "JR Simon"
                            3 => "VS Viana"
                            4 => "AM Sallum"
                            5 => "KT Kozu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/0961203321998427"
                      "Revista" => array:7 [
                        "tituloSerie" => "Lupus"
                        "fecha" => "2021"
                        "volumen" => "30"
                        "numero" => "5"
                        "paginaInicial" => "856"
                        "paginaFinal" => "860"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33653193"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0018"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "COVID-19 in 7780 pediatric patients&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A Hoang"
                            1 => "K Chorath"
                            2 => "A Moreira"
                            3 => "M Evans"
                            4 => "F Burmeister-Morton"
                            5 => "F Burmeister"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "EClinicalMedicine"
                        "fecha" => "2020"
                        "volumen" => "24"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0019"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "&#40;CDC&#41; CDCaP&#46; Symptoms of coronavirus &#40;COVID-19&#41; 2021 &#91;April 14&#44; 2021&#93;&#46;"
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "MFB Pereira"
                            1 => "N Litvinov"
                            2 => "SCL Farhat"
                            3 => "AP Eisencraft"
                            4 => "MABC Gibelli"
                            5 => "WB Carvalho"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.6061/clinics/2020/e2209"
                      "Revista" => array:5 [
                        "tituloSerie" => "Clinics"
                        "fecha" => "2020"
                        "volumen" => "75"
                        "paginaInicial" => "e2209"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32844958"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0021"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Organization WH&#46; Adolescence&#58; a period needing special attention - recognizing-adolescence&#46; 2021&#46;"
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0022"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mechanism of action of rituximab"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "T Cerny"
                            1 => "B Borisch"
                            2 => "M Introna"
                            3 => "P Johnson"
                            4 => "AL Rose"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Anticancer Drugs"
                        "fecha" => "2002"
                        "volumen" => "13"
                        "numero" => "suppl 2"
                        "paginaInicial" => "S3"
                        "paginaFinal" => "10"
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109797004865"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0023"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mechanisms of action of intravenous immunoglobulin"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B Chaigne"
                            1 => "L&#46; Mouthon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.transci.2016.12.017"
                      "Revista" => array:8 [
                        "tituloSerie" => "Transfus Apher Sci"
                        "fecha" => "2017"
                        "volumen" => "56"
                        "numero" => "1"
                        "paginaInicial" => "45"
                        "paginaFinal" => "49"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28161150"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109702029637"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0024"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intravenous immunoglobulin&#58; immunomodulatory key of the immune system"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R Ramos-Medina"
                            1 => "AL Corb&#237;"
                            2 => "S S&#225;nchez-Ram&#243;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Clin"
                        "fecha" => "2012"
                        "volumen" => "139"
                        "numero" => "3"
                        "paginaInicial" => "112"
                        "paginaFinal" => "117"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Sul SEDS-CEDVES-GdEdRGd&#46; Guia para a utiliza&#231;&#227;o dos testes r&#225;pidos de anticorpos SARS-CoV-2 antibody test&#174; da marca Wondfo 2021 &#91;april 15&#44; 2021&#93;&#46;"
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0026"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "S&#46;A&#46; CB&#46; Informativo t&#233;cnico 3&#58; Esclarecimento t&#233;cnico - One-Step COVID-19 Test 2020 &#91;updated April 02&#44; 2020&#59; cited 2021 April 14&#44; 2021&#93;&#46;"
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0027"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "P&#250;blica CdOdemS&#44; Sa&#250;de DpCC-C&#8211;Sdve&#44; Sa&#250;de Md&#46; Boletim Informativo 8 &#8211; Centro de Opera&#231;&#245;es de Emerg&#234;ncias em Sa&#250;de P&#250;blica&#44; Doen&#231;a pelo Coronav&#237;rus 2019 2020 &#91;April 14&#44; 2020&#93;&#46; Boletim Epidemiol&#243;gico 08&#93;&#46;"
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0028"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ethnic and regional variations in hospital mortality from COVID-19 in Brazil&#58; a cross-sectional observational study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "P Baqui"
                            1 => "I Bica"
                            2 => "V Marra"
                            3 => "A Ercole"
                            4 => "M&#46; van der Schaar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S2214-109X(20)30285-0"
                      "Revista" => array:7 [
                        "tituloSerie" => "Lancet Glob Health"
                        "fecha" => "2020"
                        "volumen" => "8"
                        "numero" => "8"
                        "paginaInicial" => "e1018"
                        "paginaFinal" => "e1026"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32622400"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0029"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Inqu&#233;rito Sorol&#243;gico Adultos &#40;&#62;18&#41; para SARS-CoV-2 - evolu&#231;&#227;o da preval&#234;ncia da infec&#231;&#227;o do MSP - Resultado das 8 fases 2021&#46; Available from&#58; <a target="_blank" href="https://www.prefeitura.sp.gov.br/cidade/secretarias/upload/saude/2020_10_13_inq_soro_adulto.pdf">https&#58;&#47;&#47;www&#46;prefeitura&#46;sp&#46;gov&#46;br&#47;cidade&#47;secretarias&#47;upload&#47;saude&#47;2020&#95;10&#95;13&#95;inq&#95;soro&#95;adulto&#46;pdf</a>&#46;"
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Peripheral blood B cell depletion after rituximab and complete response in lupus nephritis"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Garg 2"
                          "etal" => true
                          "autores" => array:5 [
                            0 => "LMG Mendez"
                            1 => "MD Cascino"
                            2 => "TR Katsumoto"
                            3 => "P Brakeman"
                            4 => "M Dall&#39;Era"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2215/CJN.01070118"
                      "Revista" => array:8 [
                        "tituloSerie" => "Clin J Am Soc Nephrol"
                        "fecha" => "2018"
                        "volumen" => "13"
                        "numero" => "10"
                        "paginaInicial" => "1502"
                        "paginaFinal" => "1509"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30089664"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109712043185"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0031"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High rates of severe disease and death due to SARS-CoV-2 infection in rheumatic disease patients treated with rituximab&#58; a descriptive study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J Loarce-Martos"
                            1 => "A Garc&#237;a-Fern&#225;ndez"
                            2 => "F L&#243;pez-Guti&#233;rrez"
                            3 => "V Garc&#237;a-Garc&#237;a"
                            4 => "L Calvo-Sanz"
                            5 => "I del Bosque-Granero"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00296-020-04699-x"
                      "Revista" => array:7 [
                        "tituloSerie" => "Rheumatol Int"
                        "fecha" => "2020"
                        "volumen" => "40"
                        "numero" => "12"
                        "paginaInicial" => "2015"
                        "paginaFinal" => "2021"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32945944"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/18075932/000000770000000C/v3_202308251443/S1807593222033117/v3_202308251443/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "94924"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/18075932/000000770000000C/v3_202308251443/S1807593222033117/v3_202308251443/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222033117?idApp=UINPBA00004N"
]
Article information
ISSN: 18075932
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 6 2 8
2024 October 34 30 64
2024 September 39 27 66
2024 August 52 20 72
2024 July 45 16 61
2024 June 31 33 64
2024 May 42 28 70
2024 April 32 14 46
2024 March 49 20 69
2024 February 28 18 46
2024 January 34 14 48
2023 December 23 21 44
2023 November 43 44 87
2023 October 35 36 71
2023 September 41 33 74
2023 August 16 11 27
2023 July 20 45 65
2023 June 34 24 58
2023 May 14 9 23
2023 April 5 6 11
2023 March 7 1 8
2023 February 9 2 11
2023 January 10 5 15
2022 December 28 3 31
Show all

Follow this link to access the full text of the article

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