El efecto de los probióticos sobre los síntomas depresivos: Un metanálisis de ensayos controlados aleatorios
DOI:
https://doi.org/10.33448/rsd-v10i9.18359Palabras clave:
Probióticos; Depresión; Trastornos del estado de ánimo; Microbioma gastrointestinal.Resumen
Cada vez hay más pruebas que indican que se produce una comunicación bidireccional entre el intestino y el cerebro a través del eje microbioma-intestino-cerebro. En consecuencia, varios estudios apuntan a un efecto positivo de los probióticos sobre la sintomatología depresiva. Nuestro estudio tuvo como objetivo proporcionar un metanálisis actualizado sobre el tema. Realizamos una búsqueda sistemática de ensayos clínicos aleatorios en múltiples bases de datos. El análisis de datos se realizó utilizando el Review Manager 5.4. Revisamos 26 estudios, con un total de 2170 participantes. El uso de probióticos tuvo un efecto significativo en la reducción de los síntomas depresivos (DME: - 0,22; IC del 95%: - 0,30 a - 0,13; p <0,0001) en comparación con el placebo. Los análisis de subgrupos mostraron que los probióticos influyeron en los resultados en los participantes con depresión (DME: - 0,67; IC del 95%: - 0,93 a - 0,41; p <0,00001) y con otros diagnósticos clínicos (DME: - 0,23; IC del 95%: - 0,36 a - 0,09; p = 0,0008) pero no participantes sanos (DME: - 0,11; IC del 95%: - 0,23 a 0,02; p = 0,100). El uso de probióticos puede ser un enfoque prometedor para mejorar el tratamiento de la depresión. Es importante realizar más estudios para evaluar mejor la eficacia de los probióticos como tratamiento adyuvante de los medicamentos antidepresivos, así como sus dosis más efectivas.
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Akkasheh, G., Kashani-Poor, Z., Tajabadi-Ebrahimi, M., Jafari, P., Akbari, H., Taghizadeh, M., Memarzadeh, M. R., Asemi, Z., & Esmaillzadeh, A. (2016). Clinical and metabolic response to probiotic administration in patients with major depressive disorder: A randomized, double-blind, placebo-controlled trial. Nutrition, 32(3), 315–320. https://doi.org/10.1016/j.nut.2015.09.003
Astó, E., Méndez, I., Audivert, S., Farran-Codina, A., & Espadaler, J. (2019). The efficacy of probiotics, prebiotic inulin-type fructans, and synbiotics in human ulcerative colitis: A systematic review and meta-analysis. Nutrients, 11(2), 1–16. https://doi.org/10.3390/nu11020293
Barrett, E., Ross, R. P., O’Toole, P. W., Fitzgerald, G. F., & Stanton, C. (2012). γ-Aminobutyric acid production by culturable bacteria from the human intestine. Journal of Applied Microbiology, 113(2), 411–417. https://doi.org/10.1111/j.1365-2672.2012.05344.x
Bercik, P., Park, A. J., Sinclair, D., Khoshdel, A., Lu, J., Huang, X., Deng, Y., Blennerhassett, P. A., Fahnestock, M., Moine, D., Berger, B., Huizinga, J. D., Kunze, W., Mclean, P. G., Bergonzelli, G. E., Collins, S. M., & Verdu, E. F. (2011). The anxiolytic effect of Bifidobacterium longum NCC3001 involves vagal pathways for gut-brain communication. Neurogastroenterology and Motility, 23(12), 1132–1139. https://doi.org/10.1111/j.1365-2982.2011.01796.x
Chahwan, B., Kwan, S., Isik, A., van Hemert, S., Burke, C., & Roberts, L. (2019). Gut feelings: A randomised, triple-blind, placebo-controlled trial of probiotics for depressive symptoms. Journal of Affective Disorders, 253(April), 317–326. https://doi.org/10.1016/j.jad.2019.04.097
Chung, Y. C., Jin, H. M., Cui, Y., Kim, D. S., Jung, J. M., Park, J. Il, Jung, E. S., Choi, E. K., & Chae, S. W. (2014). Fermented milk of Lactobacillus helveticus IDCC3801 improves cognitive functioning during cognitive fatigue tests in healthy older adults. Journal of Functional Foods, 10, 465–474. https://doi.org/10.1016/j.jff.2014.07.007
Daulatzai, M. A. (2014). Chronic functional bowel syndrome enhances gut-brain axis dysfunction, neuroinflammation, cognitive impairment, and vulnerability to dementia. Neurochemical Research, 39(4), 624–644. https://doi.org/10.1007/s11064-014-1266-6
Dawe, J. P., McCowan, L. M. E., Wilson, J., Okesene-Gafa, K. A. M., & Serlachius, A. S. (2020). Probiotics and Maternal Mental Health: A Randomised Controlled Trial among Pregnant Women with Obesity. Scientific Reports, 10(1), 1–11. https://doi.org/10.1038/s41598-020-58129-w
DeCastro, M., Nankova, B. B., Shah, P., Patel, P., Mally, P. V., Mishra, R., & La Gamma, E. F. (2005). Short chain fatty acids regulate tyrosine hydroxylase gene expression through a cAMP-dependent signaling pathway. Molecular Brain Research, 142(1), 28–38. https://doi.org/10.1016/j.molbrainres.2005.09.002
Desbonnet, L., Garrett, L., Clarke, G., Bienenstock, J., & Dinan, T. G. (2008). The probiotic Bifidobacteria infantis: An assessment of potential antidepressant properties in the rat. Journal of Psychiatric Research, 43(2), 164–174. https://doi.org/10.1016/j.jpsychires.2008.03.009
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997). Bias in meta-analysis detected by a simple, graphical test. British Medical Journal, 315(7109), 629–634. https://doi.org/10.1136/bmj.315.7109.629
Ford, A. C., Harris, L. A., Lacy, B. E., Quigley, E. M. M., & Moayyedi, P. (2018). Systematic review with meta-analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome. Alimentary Pharmacology and Therapeutics, 48(10), 1044–1060. https://doi.org/10.1111/apt.15001
Foster, J. A., & McVey Neufeld, K. A. (2013). Gut-brain axis: How the microbiome influences anxiety and depression. Trends in Neurosciences, 36(5), 305–312. https://doi.org/10.1016/j.tins.2013.01.005
Ghorbani, Z., Nazari, S., Etesam, F., Nourimajd, S., Ahmadpanah, M., & Razeghi Jahromi, S. (2018). The Effect of Synbiotic as an Adjuvant Therapy to Fluoxetine in Moderate Depression: A Randomized Multicenter Trial. Archives of Neuroscience, 5(2). https://doi.org/10.5812/archneurosci.60507
Goh, K. K., Liu, Y. W., Kuo, P. H., Chung, Y. C. E., Lu, M. L., & Chen, C. H. (2019). Effect of probiotics on depressive symptoms: A meta-analysis of human studies. Psychiatry Research, 282(September), 112568. https://doi.org/10.1016/j.psychres.2019.112568
Guo, Q., Goldenberg, J. Z., Humphrey, C., El Dib, R., & Johnston, B. C. (2019). Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database of Systematic Reviews, 2019(4), 1–102. https://doi.org/10.1002/14651858.CD004827.pub5.
Harro, J. (2019). Animal models of depression: pros and cons. Cell and Tissue Research, 377(1), 5–20. https://doi.org/10.1007/s00441-018-2973-0
Higgins, J. P. T., Altman, D. G., Gøtzsche, P. C., Jüni, P., Moher, D., Oxman, A. D., Savović, J., Schulz, K. F., Weeks, L., & Sterne, J. A. C. (2011). The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ (Online), 343(7829), 1–9. https://doi.org/10.1136/bmj.d5928
Huuskonen, J., Suuronen, T., Nuutinen, T., Kyrylenko, S., & Salminen, A. (2004). Regulation of microglial inflammatory response by sodium butyrate and short-chain fatty acids. British Journal of Pharmacology, 141(5), 874–880. https://doi.org/10.1038/sj.bjp.0705682
Jamilian, M., Mansury, S., Bahmani, F., Heidar, Z., Amirani, E., & Asemi, Z. (2018). The effects of probiotic and selenium co-supplementation on parameters of mental health, hormonal profiles, and biomarkers of inflammation and oxidative stress in women with polycystic ovary syndrome 11 Medical and Health Sciences 1103 Clinical Sciences. Journal of Ovarian Research, 11(1), 1–7. https://doi.org/10.1186/s13048-018-0457-1
Jiang, H., Ling, Z., Zhang, Y., Mao, H., Ma, Z., Yin, Y., Wang, W., Tang, W., Tan, Z., Shi, J., Li, L., & Ruan, B. (2015). Altered fecal microbiota composition in patients with major depressive disorder. Brain, behaviour, and immunity, 48(April), 186–194. https://doi.org/10.1016/j.bbi.2015.03.016
Kazemi, A., Noorbala, A. A., Azam, K., Eskandari, M. H., & Djafarian, K. (2019). Effect of probiotic and prebiotic vs placebo on psychological outcomes in patients with major depressive disorder: A randomized clinical trial. Clinical Nutrition, 38(2), 522–528. https://doi.org/10.1016/j.clnu.2018.04.010
Kelly, J. R., Allen, A. P., Temko, A., Hutch, W., Kennedy, P. J., Farid, N., Murphy, E., Boylan, G., Bienenstock, J., Cryan, J. F., Clarke, G., & Dinan, T. G. (2017). Lost in translation? The potential psychobiotic Lactobacillus rhamnosus (JB-1) fails to modulate stress or cognitive performance in healthy male subjects. Brain, Behavior, and Immunity, 61, 50–59. https://doi.org/10.1016/j.bbi.2016.11.018
Kong, X., Liu, J., Cetinbas, M., Sadreyev, R., Koh, M., Liu, K., & Onderdonk, A. B. (2019). New and Preliminary Evidence on Altered Oral and Disorder (ASD ): Implications for ASD Diagnosis and. Nutrients, 11, 1–26. https://doi.org/10.3390/nu11092128
Kupfer, D. J., & Regier, D. A. (2014). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
Lee, D. S., Kim, M., Nam, S. H., Kang, M. S., & Lee, S. A. (2021). Effects of oral probiotics on subjective halitosis, oral health, and psychosocial health of college students: A randomized, double-blind, placebo-controlled study. International Journal of Environmental Research and Public Health, 18(3), 1–10. https://doi.org/10.3390/ijerph18031143
Li, H., Ge, S., Greene, B., & Dunbar-Jacob, J. (2019). Depression in the context of chronic diseases in the United States and China. International Journal of Nursing Sciences, 6(1), 117–122. https://doi.org/10.1016/j.ijnss.2018.11.007
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS Medicine, 6(7), 1–28. https://doi.org/10.1371/journal.pmed.1000100
Liu, Y. W., Liu, W. H., Wu, C. C., Juan, Y. C., Wu, Y. C., Tsai, H. P., Wang, S., & Tsai, Y. C. (2016). Psychotropic effects of Lactobacillus plantarum PS128 in early life-stressed and naïve adult mice. Brain Research, 1631, 1–12. https://doi.org/10.1016/j.brainres.2015.11.018
Ma, Z. F., Yusof, N., Hamid, N., Lawenko, R. M., Wan Mohammad, W. M. Z., Liong, M. T., Sugahara, H., Odamaki, T., Xiao, J., & Lee, Y. Y. (2019). Bifidobacterium infantis M-63 improves mental health in victims with irritable bowel syndrome developed after a major flood disaster. Beneficial Microbes, 10(2), 111–120. https://doi.org/10.3920/BM2018.0008
Marvel, F. A., Chen, C. C., Badr, N., Gaykema, R. P. A., & Goehler, L. E. (2004). Reversible inactivation of the dorsal vagal complex blocks lipopolysaccharide-induced social withdrawal and c-Fos expression in central autonomic nuclei. Brain, Behavior, and Immunity, 18(2), 123–134. https://doi.org/10.1016/j.bbi.2003.09.004
McCormack, J., & Korownyk, C. (2018). Effectiveness of antidepressants. BMJ (Online), 360, 9–10. https://doi.org/10.1136/bmj.k1073
Messaoudi, M., Lalonde, R., Violle, N., Javelot, H., Desor, D., Nejdi, A., Bisson, J. F., Rougeot, C., Pichelin, M., Cazaubiel, M., & Cazaubiel, J. M. (2011). Assessment of psychotropic-like properties of a probiotic formulation (Lactobacillus helveticus R0052 and Bifidobacterium longum R0175) in rats and human subjects. British Journal of Nutrition, 105(5), 755–764. https://doi.org/10.1017/S0007114510004319
Mohammadi, A. A., Jazayeri, S., Khosravi-Darani, K., Solati, Z., Mohammadpour, N., Asemi, Z., Adab, Z., Djalali, M., Tehrani-Doost, M., Hosseini, M., & Eghtesadi, S. (2016). The effects of probiotics on mental health and hypothalamic–pituitary–adrenal axis: A randomized, double-blind, placebo-controlled trial in petrochemical workers. Nutritional Neuroscience, 19(9), 387–395. https://doi.org/10.1179/1476830515Y.0000000023
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., Altman, D., Antes, G., Atkins, D., Barbour, V., Barrowman, N., Berlin, J. A., Clark, J., Clarke, M., Cook, D., D’Amico, R., Deeks, J. J., Devereaux, P. J., Dickersin, K., Egger, M., Ernst, E., … Tugwell, P. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6(7), 1–7. https://doi.org/10.1371/journal.pmed.1000097
Moludi, J., Alizadeh, M., Mohammadzad, M. H. S., & Davari, M. (2019). The Effect of Probiotic Supplementation on Depressive Symptoms and Quality of Life in Patients after Myocardial Infarction: Results of a Preliminary Double-Blind Clinical Trial. Psychosomatic Medicine, 81(9), 770–777. https://doi.org/10.1097/PSY.0000000000000749
Moludi, J., Khedmatgozar, H., Nachvak, S. M., Abdollahzad, H., Moradinazar, M., & Sadeghpour tabaei, A. (2021). The effects of co-administration of probiotics and prebiotics on chronic inflammation, and depression symptoms in patients with coronary artery diseases: a randomized clinical trial. Nutritional Neuroscience, 0(0), 1–10. https://doi.org/10.1080/1028415X.2021.1889451
Myers, B., & Greenwood-Van Meerveld, B. (2009). Role of anxiety in the pathophysiology of irritable bowel syndrome: Importance of the amygdala. Frontiers in Neuroscience, 3(47), 1–10. https://doi.org/10.3389/neuro.21.002.2009
Ng, Q. X., Peters, C., Ho, C. Y. X., Lim, D. Y., & Yeo, W. S. (2018). A meta-analysis of the use of probiotics to alleviate depressive symptoms. Journal of Affective Disorders, 228, 13–19. https://doi.org/10.1016/j.jad.2017.11.063
Nishida, K., Sawada, D., Kuwano, Y., Tanaka, H., & Rokutan, K. (2019). Health benefits of lactobacillus gasseri cp2305 tablets in young adults exposed to chronic stress: A randomized, double-blind, placebo-controlled study. Nutrients, 11(8). https://doi.org/10.3390/nu11081859
Nishihira, J., Kagami-Katsuyama, H., Tanaka, A., Nishimura, M., Kobayashi, T., & Kawasaki, Y. (2014). Elevation of natural killer cell activity and alleviation of mental stress by the consumption of yogurt containing Lactobacillus gasseri SBT2055 and Bifidobacterium longum SBT2928 in a double-blind, placebo-controlled clinical trial. Journal of Functional Foods, 11(C), 261–268. https://doi.org/10.1016/j.jff.2014.09.002
Niu, H. L., & Xiao, J. Y. (2020). The efficacy and safety of probiotics in patients with irritable bowel syndrome: Evidence based on 35 randomized controlled trials. International Journal of Surgery, 75(80), 116–127. https://doi.org/10.1016/j.ijsu.2020.01.142
Ostadmohammadi, V., Jamilian, M., Bahmani, F., & Asemi, Z. (2019). Vitamin D and probiotic co-supplementation affects mental health, hormonal, inflammatory and oxidative stress parameters in women with polycystic ovary syndrome. Journal of Ovarian Research, 12(1), 1–8. https://doi.org/10.1186/s13048-019-0480-x
Östlund-Lagerström, L., Kihlgren, A., Repsilber, D., Björkstén, B., Brummer, R. J., & Schoultz, I. (2016). Probiotic administration among free-living older adults: A double blinded, randomized, placebo-controlled clinical trial. Nutrition Journal, 15(1), 1–10. https://doi.org/10.1186/s12937-016-0198-1
Petra, A. I., Panagiotidou, S., Hatziagelaki, E., Stewart, J. M., Conti, P., & Theoharides, T. C. (2015). Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders with Suspected Immune Dysregulation. Clinical Therapeutics, 37(5), 984–995. https://doi.org/10.1016/j.clinthera.2015.04.002
Pinto-Sanchez, M. I., Hall, G. B., Ghajar, K., Nardelli, A., Bolino, C., Lau, J. T., Martin, F. P., Cominetti, O., Welsh, C., Rieder, A., Traynor, J., Gregory, C., De Palma, G., Pigrau, M., Ford, A. C., Macri, J., Berger, B., Bergonzelli, G., Surette, M. G., … Bercik, P. (2017). Probiotic Bifidobacterium longum NCC3001 Reduces Depression Scores and Alters Brain Activity: A Pilot Study in Patients With Irritable Bowel Syndrome. Gastroenterology, 153(2), 448-459.e8. https://doi.org/10.1053/j.gastro.2017.05.003
Raygan, F., Ostadmohammadi, V., & Asemi, Z. (2019). The effects of probiotic and selenium co-supplementation on mental health parameters and metabolic profiles in type 2 diabetic patients with coronary heart disease: A randomized, double-blind, placebo-controlled trial. Clinical Nutrition, 38(4), 1594–1598. https://doi.org/10.1016/j.clnu.2018.07.017
Raygan, F., Ostadmohammadi, V., Bahmani, F., & Asemi, Z. (2018). The effects of vitamin D and probiotic co-supplementation on mental health parameters and metabolic status in type 2 diabetic patients with coronary heart disease: A randomized, double-blind, placebo-controlled trial. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 84, 50–55. https://doi.org/10.1016/j.pnpbp.2018.02.007
Reininghaus, E. Z., Platzer, M., Kohlhammer-Dohr, A., Hamm, C., Mörkl, S., Bengesser, S. A., Fellendorf, F. T., Lahousen-Luxenberger, T., Leitner-Afschar, B., Schöggl, H., Amberger-Otti, D., Wurm, W., Queissner, R., Birner, A., Falzberger, V. S., Painold, A., Fitz, W., Brunnmayr, M., Rieger, A., … Dalkner, N. (2020). Provit: Supplementary probiotic treatment and vitamin b7 in depression—a randomized controlled trial. Nutrients, 12(11), 1–17. https://doi.org/10.3390/nu12113422
Roman, P., Estévez, A. F., Miras, A., Sánchez-Labraca, N., Cañadas, F., Vivas, A. B., & Cardona, D. (2018). A Pilot Randomized Controlled Trial to Explore Cognitive and Emotional Effects of Probiotics in Fibromyalgia. Scientific Reports, 8(1), 1–9. https://doi.org/10.1038/s41598-018-29388-5
Romijn, A. R., Rucklidge, J. J., Kuijer, R. G., & Frampton, C. (2017). A double-blind, randomized, placebo-controlled trial of Lactobacillus helveticus and Bifidobacterium longum for the symptoms of depression. Australian and New Zealand Journal of Psychiatry, 51(8), 810–821. https://doi.org/10.1177/0004867416686694
Sender, R., Fuchs, S., & Milo, R. (2016). Revised Estimates for the Number of Human and Bacteria Cells in the Body. PLoS Biology, 14(8), 1–14. https://doi.org/10.1371/journal.pbio.1002533
Sherwin, E., Sandhu, K. V., Dinan, T. G., & Cryan, J. F. (2016). May the Force Be With You: The Light and Dark Sides of the Microbiota–Gut–Brain Axis in Neuropsychiatry. CNS Drugs, 30(11), 1019–1041. https://doi.org/10.1007/s40263-016-0370-3
Siegel, M. P., & Conklin, S. M. (2020). Acute intake of B. longum probiotic does not reduce stress, anxiety, or depression in young adults: A pilot study. Brain, Behavior, & Immunity - Health, 2(January), 100029. https://doi.org/10.1016/j.bbih.2019.100029
Simrén, M., Öhman, L., Olsson, J., Svensson, U., Ohlson, K., Posserud, I., & Strid, H. (2010). Clinical trial: The effects of a fermented milk containing three probiotic bacteria in patients with irritable bowel syndrome - A randomized, double-blind, controlled study. Alimentary Pharmacology and Therapeutics, 31(2), 218–227. https://doi.org/10.1111/j.1365-2036.2009.04183.x
Slykerman, R. F., Hood, F., Wickens, K., Thompson, J. M. D., Barthow, C., Murphy, R., Kang, J., Rowden, J., Stone, P., Crane, J., Stanley, T., Abels, P., Purdie, G., Maude, R., & Mitchell, E. A. (2017). Effect of Lactobacillus rhamnosus HN001 in Pregnancy on Postpartum Symptoms of Depression and Anxiety: A Randomised Double-blind Placebo-controlled Trial. EBioMedicine, 24, 159–165. https://doi.org/10.1016/j.ebiom.2017.09.013
Smith-ryan, A. E., Mock, M. G., Trexler, E. T., Hirsch, K. R., & Blue, M. N. M. (n.d.). Influence of a multi-strain probiotic on body composition and mood in female occupational shift-workers 1 Applied Physiology Laboratory, Department of Exercise and Sport Science , The University of North Carolina , Chapel Hill , NC , 27599 ; meremock@gma. 1–36.
Stasi, C., Caserta, A., Nisita, C., Cortopassi, S., Fani, B., Salvadori, S., Pancetti, A., Bertani, L., Gambaccini, D., de Bortoli, N., Dell’Osso, L., Blandizzi, C., Marchi, S., & Bellini, M. (2019). The complex interplay between gastrointestinal and psychiatric symptoms in irritable bowel syndrome: A longitudinal assessment. Journal of Gastroenterology and Hepatology (Australia), 34(4), 713–719. https://doi.org/10.1111/jgh.14375
Steenbergen, L., Sellaro, R., van Hemert, S., Bosch, J. A., & Colzato, L. S. (2015). A randomized controlled trial to test the effect of multispecies probiotics on cognitive reactivity to sad mood. Brain, Behavior, and Immunity, 48, 258–264. https://doi.org/10.1016/j.bbi.2015.04.003
Venkataraman, R., Madempudi, R. S., Neelamraju, J., Ahire, J. J., Vinay, H. R., Lal, A., Thomas, G., & Stephen, S. (2021). Effect of Multi-strain Probiotic Formulation on Students Facing Examination Stress: a Double-Blind, Placebo-Controlled Study. Probiotics and Antimicrobial Proteins, 13(1), 12–18. https://doi.org/10.1007/s12602-020-09681-4
World Health Organization. (2001). The World Health Report 2001.
World Health Organization. (2017). Depression and Other Common Mental Disorders. In Global Health Estimates (pp. 3–20). https://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf;jsessionid=E00B1CEF3F2485F726AC7B255BEB4758?sequence=1
Zhang, Y., Li, L., Guo, C., Mu, D., Feng, B., Zuo, X., & Li, Y. (2016). Effects of probiotic type, dose and treatment duration on irritable bowel syndrome diagnosed by Rome III criteria: A meta-analysis. BMC Gastroenterology, 16(1), 1–11. https://doi.org/10.1186/s12876-016-0470-z
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Derechos de autor 2021 Vitor Palmares Oliveira e Silva; Marcelo Palmares Oliveira e Silva; Carlos Roberto Weber Sobrinho; Rodrigo Coelho Marques; Flávio Cardoso de Souza Júnior; Marcílio Lins Aroucha
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