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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Body sculpting is an increasingly common practice in modern society&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a> Some enthusiasts resort to substance abuse to boost results&#44; despite the serious health risks involved&#46; A number of commercially available substances&#44; from anabolic steroids &#40;hormones promoting muscle anabolism&#41; to oily compounds &#40;increasing muscle volume by way of retention&#44; without contributing to anabolism&#41;&#44; are known to cause severe damage to the organism&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">One such substance is the compound &#8220;ADE&#8221;&#44; a veterinary product containing liposoluble vitamin A&#44; D and E&#44; indicated for the treatment of vitamin deficiency and infection in cattle and horses&#46; According to the manufacturers&#44; animals should not be injected with more than 5<span class="elsevierStyleHsp" style=""></span>mL per 120-day period of fattening&#46; However&#44; much higher doses are used by human body sculptors&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">2</span></a> The injection of ADE produces a local granulomatous reaction and encapsulation&#46; If encapsulation fails&#44; or if the substance enters the blood stream&#44; embolism may occur&#44; in some cases followed by death&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">2</span></a> In Brazil&#44; human ADE use was first described in the late 1980s&#44; but may have started earlier&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The purpose of the present study was to evaluate the occurrence of acute kidney injury &#40;AKI&#41; or chronic kidney disease &#40;CKD&#41; in a series of patients admitted to two Brazilian referral hospitals due to complications from excessive and prolonged intramuscular injection of ADE vitamins&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Patients and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Study design</span><p id="par0020" class="elsevierStylePara elsevierViewall">This is a descriptive study based on a case series&#46; We have evaluated a series of 16 patients with kidney complications resulting from the use of veterinary intramuscular vitamin supplements containing high doses of vitamin A&#44; D and E&#46; The patients were admitted to two referral hospitals in Fortaleza &#40;Northeastern Brazil&#41; between January 2010 and January 2015&#46; Patients with a history of renal failure&#44; hypertension&#44; diabetes mellitus&#44; nephrolithiasis&#44; nephrotoxic drug use&#44; or any comorbidity potentially detrimental to renal function&#44; were excluded from the analysis&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Vitamin supplements used</span><p id="par0025" class="elsevierStylePara elsevierViewall">All studied patients have used vitamin supplements containing vitamins A&#44; D and E&#46; In each 100<span class="elsevierStyleHsp" style=""></span>mL the following composition was observed&#58; vitamin A 20&#44;000&#44;000<span class="elsevierStyleHsp" style=""></span>IU&#44; vitamin D 35&#44;000&#44;000<span class="elsevierStyleHsp" style=""></span>IU and vitamin E 6000<span class="elsevierStyleHsp" style=""></span>IU&#44; which represents a very high dose&#44; higher than the recommended daily intake for humans&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Study parameters</span><p id="par0030" class="elsevierStylePara elsevierViewall">Information was collected on demographics&#44; length of hospital stay&#44; clinical manifestations&#44; laboratory findings&#44; need for dialysis&#44; treatment and mortality&#46; Clinical information included all clinical signs and symptoms registered upon admission and during hospitalization&#46; The laboratory tests included complete blood count&#44; serum urea&#44; creatinine&#44; sodium&#44; potassium&#44; calcium&#44; aspartate aminotransferase&#44; alanine aminotransferase&#44; parathyroid hormone &#40;PTH&#41;&#44; vitamin D and urinalysis&#46; Twenty-four-hour urinary calcium levels were also registered&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Definitions</span><p id="par0035" class="elsevierStylePara elsevierViewall">AKI and CKD were diagnosed and classified according to KDIGO criteria&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">4</span></a> Due to lack of information on serum creatinine levels prior to admission&#44; all patients were assumed to have a baseline glomerular filtration rate of 100<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;m<span class="elsevierStyleSup">2</span>&#46; The patients were classified as the highest KDIGO stage observed during hospitalization&#46; Oliguria was defined as a urine output &#60;0&#46;5<span class="elsevierStyleHsp" style=""></span>mL&#47;kg&#47;h&#46; Dialysis was indicated for patients who remained oliguric after effective hydration for at least 24<span class="elsevierStyleHsp" style=""></span>h&#44; for refractory hypervolemia&#44; severe metabolic acidosis or uremia&#46; High blood pressure was defined as systolic blood pressure &#8805;140<span class="elsevierStyleHsp" style=""></span>mmHg and&#47;or diastolic blood pressure &#8805;90<span class="elsevierStyleHsp" style=""></span>mmHg&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Ethical aspects</span><p id="par0040" class="elsevierStylePara elsevierViewall">The study protocol was reviewed and approved by the Research Ethics Committees of the General Hospital of Fortaleza and the Walter Cant&#237;dio University Hospital&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">Patients&#8217; mean age was 28&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;9 years &#40;19&#8211;53 years&#41;&#44; and 11 &#40;68&#46;7&#37;&#41; were male&#46; Mean length of hospital stay was 15<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13 days &#40;1&#8211;52 days&#41;&#46; Upon admission&#44; all patients reported a history of intramuscular injection of vitamin supplements containing vitamins A&#44; D and E for esthetic purposes&#46; Six patients reported concurrent use of anabolic steroids&#46; All were body building practitioners and attended gyms regularly&#46; The median time between the last injection and hospitalization was 10 months &#40;range&#58; 1&#8211;48 months&#41;&#46; The median time between the first use and hospitalization was 28 months &#40;range&#58; 4&#8211;60 months&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes patients&#8217; clinical and laboratory characteristics&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Main signs and symptoms upon admission were nausea &#40;68&#46;7&#37;&#41;&#44; vomiting &#40;62&#46;5&#37;&#41;&#44; weight loss &#40;43&#46;7&#37;&#41;&#44; epigastric pain &#40;31&#46;2&#37;&#41; and headache &#40;31&#46;2&#37;&#41;&#44; fever &#40;25&#37;&#41;&#44; paresthesia in the upper and lower limbs &#40;25&#37;&#41;&#44; polyuria &#40;18&#46;7&#37;&#41;&#44; syncope &#40;18&#46;7&#37;&#41; and anorexia &#40;18&#46;7&#37;&#41;&#46; Patients also reported low back pain&#44; edema&#44; nocturia and pallor &#40;12&#46;5&#37; each&#41;&#44; and gynecomastia and lymphadenopathy &#40;6&#46;2&#37; each&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">At hospital admission the mean laboratory values were&#58; hemoglobin 10<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;0<span class="elsevierStyleHsp" style=""></span>g&#47;dL &#40;range 6&#46;1&#8211;14&#46;2&#41;&#44; leukocytes 10&#44;542<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4871&#47;mm<span class="elsevierStyleSup">3</span> &#40;4100&#8211;15100&#41;&#44; creatinine 3&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;0&#46;7&#8211;22&#41; and urea 91<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>88<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;22&#8211;306&#41;&#44; respectively&#46; Serum calcium level was 12<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;8&#46;8&#8211;15&#46;5&#41;&#44; 24-h urine calcium level was 575<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>329<span class="elsevierStyleHsp" style=""></span>mg &#40;10&#46;7&#8211;1058&#41;&#44; median PTH level was 55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>141<span class="elsevierStyleHsp" style=""></span>pg&#47;mL &#40;2&#8211;406&#41;&#44; and serum vitamin D concentration was 135<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>75<span class="elsevierStyleHsp" style=""></span>ng&#47;mL &#40;22&#8211;265&#41;&#46; During hospital stay maximum creatinine ranged from 0&#46;8 to 8&#46;6<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;mean 4&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41; and serum calcium from 10&#46;2 to 16&#46;8<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;mean 13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41;&#46; Laboratory findings for each patient are summarized in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Three patients had imaging findings compatible with nephrocalcinosis and seven had nephrolithiasis&#46; Using KDIGO criteria&#44; AKI was diagnosed in 13 cases &#40;81&#46;2&#37;&#41; and classified as stage 1 &#40;23&#37;&#41;&#44; stage 2 &#40;23&#37;&#41; or stage 3 &#40;54&#37;&#41;&#46; No deaths occurred in the study period&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Treatment consisted primarily of controlling calcium levels and complications such as acute pancreatitis due to hypercalcemia &#40;18&#46;7&#37;&#41; and local infections &#40;18&#46;7&#37;&#41; resulting from intramuscular injections of vitamin supplements without sterilization&#46; Hypercalcemia was treated with vigorous hydration&#44; steroids and loop diuretics&#46; Due to severe AKI&#44; two patients required dialysis&#46; One &#40;&#35;11&#41; received 5 hemodialysis sessions during hospitalization&#46; The other &#40;&#35;15&#41; developed chronic kidney disease and was started on regular hemodialysis three times a week&#46; Six previously non-hypertensive patients presented hypertensive peaks upon admission&#46; Hypertension persisted in four cases who were discharged with prescriptions for anti-hypertensive drugs&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">A considerable number of patients with severe kidney complications &#40;including chronic kidney failure&#41; from excessive use of vitamin supplements are described in this study&#46; Kidney injury due to vitamin abuse is seldom reported in literature and it seems to be a frequent complication&#44; at least among patients taking very high doses of vitamins &#40;veterinary doses&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">5</span></a> The possible mechanisms involved in the pathophysiology of kidney injury associated with hypercalcemia and injectable vitamins A&#44; D and E supplements is schematized in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">As in other granulomatous conditions&#44; such as tuberculosis&#44; sarcoidosis and fungal infections&#44; vitamin D is converted extra-renal into its active form by granuloma cells &#40;especially macrophages&#41;&#46; This increases the intestinal absorption of vitamin D-dependent calcium and raises serum calcium levels&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">6</span></a> Hypercalcemia and high level of 1&#46;25&#40;OH&#41;<span class="elsevierStyleInf">2</span>D<span class="elsevierStyleInf">3</span> concentrations have a negative impact on the parathyroid glands&#44; reducing PTH production and serum levels&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">7</span></a> This pattern was observed in most of our patients and in most patients reported in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">5&#44;8&#8211;10</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">On the other hand&#44; some believe hypervitaminosis is the result of the absorption of injected vitamin D&#46; Further studies are necessary to clarify the mechanisms involved&#44; but the fact that a similar reaction occurs when other substances &#40;such as paraffin&#41; are injecting into the muscle&#44; along with the observed late onset of hypercalcemia &#40;months later&#41;&#44; point to granuloma formation and extra-renal conversion as the most likely explanation&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a> If the absorption of injected vitamin D were the culprit&#44; the onset of hypercalcemia would be acute&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">11&#8211;13</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The effects of hypervitaminosis A and E in humans are less studied than hipervitaminosis D&#46; It is known that after consumption of high doses of vitamin A the concentrations of retinoids and metabolites are elevated in plasma&#46; Toxicity following high consumption of vitamin A can be acute &#40;intake &#62;660&#44;000<span class="elsevierStyleHsp" style=""></span>IU&#41; or chronic&#44; when intake lasts for months or years &#40;a dose &#62;100&#44;000<span class="elsevierStyleHsp" style=""></span>IU for more than 6 months is considered toxic&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">14&#44;15</span></a> and our patients consumed a dose very higher than the levels considered toxic&#46; The main effects of hypervitaminosis A are related to bone metabolism&#46; There is association between high vitamin A intake and osteoporosis and pathological fractures&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> Other signs and symptoms of vitamin A toxicity includes include dry skin&#44; nausea&#44; headache&#44; fatigue&#44; irritability&#44; anorexia&#44; liver disease&#44; hair loss and alopecia&#44; hyperostosis&#44; high cholesterol and increased cerebrospinal fluid pressure&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">15</span></a> Hypervitaminosis E is rare&#44; but it is possible to be more frequent once consumption of this vitamin is increasing due to its potentially antioxidant and antiatherogenic effects&#46; Toxic effects of hypervitaminosis E includes prolongation of prothrombin time and hemorrhage &#40;due to antagonist effects of vitamin E against vitamin K&#41;&#44; hypertension&#44; angina and stroke&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">16</span></a> Our patients had nausea&#44; vomiting and headache&#44; which could be attributable to hypervitaminosis A and E&#44; but these symptoms could also be consequence of AKI-associated uremia&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In the present case series&#44; kidney injury ranged from relatively mild and reversible acute injury to severe disease progressing to end-stage chronic kidney failure &#40;as observed in patient &#35;15&#41;&#46; Persistent hypercalcemia with serum calcium levels &#62;11<span class="elsevierStyleHsp" style=""></span>mg&#47;dL may in up to 20&#37; of cases develop into nephrogenic diabetes insipidus&#44; which usually reverts with the resolution of the hypercalcemic condition&#46; Though not yet fully understood&#44; the mechanism of nephrogenic diabetes insipidus possibly involves the inhibition of reabsorption of sodium chloride in the thick ascending limb of the loop of Henle &#40;in detriment to countercurrent exchange&#41; and of vasopressin-mediated water permeability in the terminal collecting duct&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Hypercalcemia has been shown to downregulate aquaporine 2 protein expression in rat kidney medulla&#44; interfering with the ability to concentrate urine&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">18</span></a> Calcium deposition in the medulla &#40;a cause of tubulointerstitial injury&#41; appears to play an important role in this process&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a> The activation of calcium-sensing receptor can affect the urinary-concentrating mechanism by acting in both the loop of Henle and the collecting tubules&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">20</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Hypercalciuria secondary to hypercalcemia also leads to the deposition of calcium in the renal parenchyma&#44; eventually causing nephrocalcinosis and irreversible damage and predisposing toward the development of chronic nephropathy&#46; When the concentration of calcium phosphate exceeds solubility&#44; Randall&#39;s plaques are formed in the basement membranes of the thin limbs of the loop of Henle in the inner medullary interstitium&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">21&#8211;23</span></a> These calcium phosphate plaques can extend into the surrounding interstitial tissue&#44; producing medullar nephrocalcinosis&#44; or penetrate the urothelium where they are believed to provide a nidus for intratubular stone formation&#44; leading to nephrolithiasis&#44; obstructive uropathy and kidney injury&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">24</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Thus&#44; nephropathy induced by vitamin supplement abuse can indeed lead to chronic kidney disease&#46; This sheds light on the findings and outcome of patient &#35;15 in our series&#46; Unlike the other patients&#44; &#35;15 had low calcium and vitamin D levels and high PTH levels&#46; Combined with anemia and the need for persistent dialysis&#44; these findings are an indication of terminal chronic kidney injury&#46; In the absence of other offending factors&#44; it may be inferred that the condition of this 25-year old patient was specifically the result of vitamin supplement abuse&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Most of our patients experienced acute kidney injury&#44; but did not develop chronic kidney disease &#40;nephrocalcinosis or hydronephrosis&#41;&#46; The observed kidney injury may have involved other mechanisms&#46; Thus&#44; serum calcium levels in excess of 12&#8211;15<span class="elsevierStyleHsp" style=""></span>mg&#47;dL can acutely induce a reversible decrease in glomerular filtration by direct renal vasoconstriction of the arterioles and decreased extracellular fluid volume due to anorexia&#44; vomiting and inability to concentrate urine &#40;nephrogenic diabetes insipidus&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a> Vomiting was a common symptom in our patients&#44; most likely due to hypercalcemia&#46; In such cases&#44; kidney function is often fully restored by early treatment&#46; On the other hand&#44; non-renal function recovery or partial recovery in patients with chronic hypercalcemia with tubular degeneration&#44; fibrosis and nephrocalcinosis are observed&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">26</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">High blood pressure observed in these patients is due mainly to hypercalcemia or kidney injury&#46; Hypercalcemia affects the vascular smooth muscle directly increasing vascular resistance&#44; and indirectly increasing catecholamines levels&#46; However&#44; the impact is much stronger on renal vascular resistance than on peripheral vascular resistance&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">27</span></a> There are also reports associating vitamin A intoxication with hypercalcemia&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">28&#44;29</span></a> Its mechanism is still poor understood and may include up-regulation of osteoclasts by retinol metabolites&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">29</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">In conclusion&#44; excessive use of veterinary vitamin supplements that containing high doses of vitamin A&#44; D and E is associated with AKI and prolonged use with CKD&#46; Hypercalcemia&#44; a common finding&#44; appears to be a contributing factor for this outcome&#46; The importance of this report is to alert the medical community to the ongoing and dangerous practice of vitamin and supplement abuse by young individuals&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Study limitations</span><p id="par0125" class="elsevierStylePara elsevierViewall">As this is a descriptive study&#44; there are some limitations&#46; We have described a small number of patients&#44; but this is representative of a rare complication &#40;AKI-associated to vitamin supplements abuse&#41;&#44; which is still not well described in literature&#46; Some laboratory tests&#44; such as creatine kinase &#40;CK&#41;&#44; to rule out rhabdomyolysis&#44; and serum vitamin D were not available for all patients due to technical and economic problems&#46; It was not possible to perform a powerful statistical analysis&#44; so it was not possible to draw statistically significant associations between possible causal factors for AKI&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflict of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to disclose&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Despite well-documented risks&#44; injectable supplements containing high doses of vitamins are commonly used&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objectives</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To describe acute kidney injury &#40;AKI&#41; as a complication of vitamin intoxication&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Our series consisted of 16 patients with kidney complications resulting from the use of veterinary intramuscular injection supplements of vitamin A&#44; D and E&#46; The patients were admitted to two referral hospitals in Fortaleza &#40;Brazil&#41; between January 2010 and January 2015&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Patients&#8217; mean age was 28&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;9 years &#40;19&#8211;53 years&#41;&#44; and 11 &#40;68&#46;7&#37;&#41; were male&#46; Main signs and symptoms upon admission were nausea &#40;68&#46;7&#37;&#41;&#44; vomiting &#40;62&#46;5&#37;&#41;&#44; weight loss &#40;43&#46;7&#37;&#41;&#44; epigastric pain &#40;31&#46;2&#37;&#41; and headache &#40;31&#46;2&#37;&#41;&#46; At hospital admission the mean laboratory values were&#58; hemoglobin 10<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;0<span class="elsevierStyleHsp" style=""></span>g&#47;dL &#40;6&#46;1&#8211;14&#46;2&#41;&#44; leukocytes 10&#44;542<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4871&#47;mm<span class="elsevierStyleSup">3</span> &#40;4100&#8211;15&#44;100&#41;&#44; creatinine 3&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;0&#46;7&#8211;22&#41; and urea 91<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>88<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;22&#8211;306&#41;&#44; respectively&#46; Serum calcium was 12<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;8&#46;8&#8211;15&#46;5&#41;&#44; 24-h urine calcium was 575<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>329<span class="elsevierStyleHsp" style=""></span>mg &#40;10&#46;7&#8211;1058&#41;&#44; serum PTH was 55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>141<span class="elsevierStyleHsp" style=""></span>pg&#47;mL &#40;2&#8211;406&#41;&#44; and serum vitamin D concentration was 135<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>75<span class="elsevierStyleHsp" style=""></span>ng&#47;mL &#40;22&#8211;265&#41;&#46; Using KDIGO criteria&#44; AKI was diagnosed in 13 patients &#40;81&#46;2&#37;&#41;&#44; classified as stage 1 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#44; stage 2 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41; or stage 3 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#41;&#46; No deaths occurred in the study period&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Excessive use of veterinary vitamin supplements containing high doses of vitamin A&#44; D and E was associated with AKI&#46; Hypercalcaemia&#44; which was a common finding&#44; appears to be a contributing factor to the development of this type of AKI&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Antecedentes</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Suplementos inyectables que contienen altas dosis de vitaminas son utilizados con frecuencia&#44; a pesar de los riesgos bien documentados&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Describir la ocurrencia de da&#241;o renal agudo &#40;IRA&#41; como complicaci&#243;n de intoxicaci&#243;n por suplementos vitam&#237;nicos&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Esta es una serie de 16 pacientes con complicaciones renales resultantes de la utilizaci&#243;n de inyecci&#243;n intramuscular de suplementos veterinarios con vitaminas A&#44; D y E&#46; Los pacientes fueron ingresados en 2 hospitales de referencia en Fortaleza &#40;Brasil&#41;&#44; entre enero de 2010 y enero de 2015&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La edad media de los pacientes fue de 28&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;9 a&#241;os &#40;19&#8211;53 a&#241;os&#41; y 11 &#40;68&#44;7&#37;&#41; eran varones&#46; Signos y s&#237;ntomas principales al ingreso fueron n&#225;useas &#40;68&#44;7&#37;&#41;&#44; v&#243;mitos &#40;62&#44;5&#37;&#41;&#44; p&#233;rdida de peso &#40;43&#44;7&#37;&#41;&#44; dolor epig&#225;strico &#40;31&#44;2&#37;&#41; y cefalea &#40;31&#44;2&#37;&#41;&#46; Al ingreso en el hospital los valores medios de laboratorio fueron&#58; hemoglobina 10<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;0<span class="elsevierStyleHsp" style=""></span>g&#47;dL &#40;6&#44;1&#8211;14&#44;2&#41;&#44; leucocitos 10&#46;542<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;871&#47;mm<span class="elsevierStyleSup">3</span> &#40;4&#46;100&#8211;15&#46;100&#41;&#44; creatinina 3&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;0&#44;7&#8211;22&#41; y urea 91<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>88<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;22&#8211;306&#41;&#44; respectivamente&#46; El nivel de calcio s&#233;rico fue de 12<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;8&#44;8&#8211;15&#44;5&#41;&#44; el de calcio en orina de 24<span class="elsevierStyleHsp" style=""></span>h fue de 575<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>329<span class="elsevierStyleHsp" style=""></span>mg &#40;10&#44;7&#8211;1&#46;058&#41;&#44; el de PTH s&#233;rico fue de 55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>141<span class="elsevierStyleHsp" style=""></span>pg&#47;mL &#40;2&#8211;406&#41; y el nivel de vitamina D s&#233;rica fue de 135<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>75<span class="elsevierStyleHsp" style=""></span>ng&#47;mL &#40;22&#8211;265&#41;&#46; Utilizando criterios KDIGO&#44; se diagnostic&#243; IRA en 13 pacientes &#40;81&#44;2&#37;&#41;&#59; fueron clasificadas como clase 1 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#44; clase 2 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41; y clase 3 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#41;&#46; No hubo muertes en el per&#237;odo de estudio&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">El uso excesivo de suplementos vitam&#237;nicos veterinarios que contienen altas dosis de vitamina A&#44; D y E se asoci&#243; con IRA&#46; La hipercalcemia&#44; un hallazgo com&#250;n&#44; parece ser un factor que contribuye al desarrollo de este tipo de IRA&#46;</p></span>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD and &#37;&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Hb&#44; hemoglobina &#40;g&#47;dL&#41;&#59; Ur&#44; urea &#40;mg&#47;dL&#41;&#59; Cr&#44; creatinine &#40;mg&#47;dL&#41;&#59; Ca&#44; calcium &#40;mg&#47;dL&#41;&#59; 24<span class="elsevierStyleHsp" style=""></span>h-Ca&#44; 24<span class="elsevierStyleHsp" style=""></span>h calciuria &#40;mg&#47;dL&#41;&#59; adm&#44; at admission&#59; max&#44; maximum at hospital stay&#59; dis&#44; at hospital discharge&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Gender</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;68&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;31&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Length of hospital stay &#40;days&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Median time between first use and admission &#40;months&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Signs and symptoms at admission</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nausea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vomiting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Weight loss&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Epigastric pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Headache&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Fever&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Paresthesia &#40;limbs&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Polyuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Syncope&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Anorexia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Low back pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Edema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nocturia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pallor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Gynecomastia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lymphadenopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">AKI</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Laboratory tests</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hb<span class="elsevierStyleInf">adm</span> &#40;g&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Leukocytes<span class="elsevierStyleInf">adm</span> &#40;1&#215;&#47;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#44;542<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4871&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cr<span class="elsevierStyleInf">adm</span> &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;9&#8211;5&#46;2<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cr<span class="elsevierStyleInf">max</span> &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cr<span class="elsevierStyleInf">dis</span> &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ur<span class="elsevierStyleInf">adm</span> &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ur<span class="elsevierStyleInf">max</span> &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">102<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ur<span class="elsevierStyleInf">dis</span> &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ca<span class="elsevierStyleInf">adm</span> &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#8211;2&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ca<span class="elsevierStyleInf">max</span> &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h-Ca &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">575<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>329&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PTH &#40;pg&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>141&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vitamin D &#40;ng&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">135<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Clinical and laboratory characteristics of 16 patients with acute kidney injury due to vitamin supplements abuse&#46;</p>"
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Ht&#44; hematocrit &#40;&#37;&#41;&#59; Hb&#44; hemoglobina &#40;g&#47;dL&#41;&#59; WBC&#44; white blood count &#40;1&#215;&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#59; platelets&#44; 1&#215;&#47;mm<span class="elsevierStyleSup">3</span>&#59; Ur&#44; urea &#40;mg&#47;dL&#41;&#59; Cr&#44; creatinine &#40;mg&#47;dL&#41;&#59; AST&#44; aspartate aminotransferase &#40;IU&#47;L&#41;&#59; ALT&#44; alanine aminotransferase &#40;IU&#47;L&#41;&#59; Na&#44; sodium &#40;mEq&#47;L&#41;&#59; K&#44; potassium &#40;mEq&#47;L&#41;&#59; Ca&#44; calcium &#40;mg&#47;dL&#41;&#59; Vit D&#44; vitamin D &#40;ng&#47;mL&#41;&#59; PTH&#44; parathyroid hormone &#40;pg&#47;dL&#41;&#59; adm&#44; at admission&#59; max&#44; maximum at hospital stay&#59; dis&#44; at hospital discharge&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#35;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Gender&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Ht adm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Hb adm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">WBC adm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Platelets adm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Ur adm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Ur max&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Ur dis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Cr adm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Cr max&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Cr dis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">AST&#47;ALT adm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">AST&#47;ALT max&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">AST&#47;ALT dis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Na adm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">K adm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Ca adm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Ca max&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Ca dis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Vit D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">24<span class="elsevierStyleHsp" style=""></span>h calciuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">PTH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7584&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">397&#44;709&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#47;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">140&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8214&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">463&#44;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#47;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#47;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#47;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">139&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">499&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">306&nbsp;\t\t\t\t\t\t\n
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