RESUMEN

Introduction: Vascular ulcers constitute a serious global public health problem, responsible for causing a significant social and economic impact due to their recurrent, disabling nature and the need for prolonged therapies to cure them. Objective: To evaluate the use and efficacy of the rhEGF in the epithelialization of patients with a diagnosis of CEAP stage 6 venous insufficiency, in the two regimes of the health system in Colombia, the contributive (equivalent to a health system where citizens with payment capacity contribute a percentage of their salary) and the subsidized (equivalent to a health system where the state covers the vulnerable population and low socioeconomic level) versus the other treatments used. Methodology: Observational, descriptive, retrospective, multicenter study, in which 105 medical records with 139 ulcers were reviewed, in 2 centers, one belonging to the subsidized system and the other to the contributive system in Colombia. Results: The association with the epithelialization variable of the different treatment groups for ulcers according to the application of the mixed effect model test, for both regimes was for the Biologicals (EC 34.401/p = 0.000), Bioactive Agents (Hydrogels) (EC 24.735/p = 0.005) groups; for the rest of the treatment groups, the results were neither associated nor statistically significant. Conclusion: Intra- and perilesional therapy with rhEGF expands the therapeutic spectrum in patients with venous ulcers, regardless of the type of health system in which it will be applied, shortening the healing time and reaching a possible therapeutic goal, which according to this study there is an association with epithelialization regardless of the regime applied.

Asunto(s)

RESUMEN

OBJECTIVE: To perform a comparative analysis of health care expenses and outcomes in response to the question: What is the cost-effectiveness of intralesional and perilesional recombinant human epidermal growth factor (rhEGF) compared with hydrocolloid therapy in patients diagnosed with chronic venous insufficiency without infection in Colombia? METHODS: A Markov model was used to determine cost effectiveness over a 5-year period, considering the perspective of the health system in Colombia. The study included patients aged >18 years diagnosed with chronic venous insufficiency and used clinical studies to calculate the probabilities of epithelialization, infection, recurrence, and mortality. RESULTS: RhEGF is more expensive per unit than hydrocolloids, but it is proven to be effective at healing ulcers in 8 to 12 weeks, even in complex cases. Hydrocolloids, in contrast, typically require 29.5 weeks on average, and ≤46 weeks for complex cases. Despite the cost, rhEGF is more cost effective because it achieves results comparable with hydrocolloid therapy at a lower cost per additional quality-adjusted life-year. CONCLUSIONS: Based on cost-effectiveness analysis, rhEGF is a superior alternative to hydrocolloids for treating venous ulcers in Colombia. Not only is it more affordable, but it also enhances patients' quality of life and streamlines the health care system's resource use.

Asunto(s)

RESUMEN

Venous Ulcers (VU) represent 60-80% of all leg ulcers and are the final stage of the disease secondary to venous hypertension or valve insufficiency. Conventional treatment that focuses on its etiological factors continues to be the gold standard; however, 30% of ulcers do not heal with this treatment; thus, it has been seen that the use of growth factor can be used as an adjuvant for this pathology. A literature review was carried out to evaluate the evidence from systematic reviews, meta-analyses, case studies, and quantitative studies that respond to the objective of this analysis review in the different databases with specific inclusion criteria with publications between 2002 and 2022, initially finding the topical application of the factor and later, more recently, the intralesional and perilesional application, the latter being an alternative treatment for this type of pathology and generating some recommendations for using the Factor.

Asunto(s)

RESUMEN

Aim: Venous ulcers are the most serious complication of chronic venous insufficiency secondary to venous hypertension and represent between 80% and 90% of all ulcers vascular, having socioeconomic repercussions and on the patient's quality of life. Objective: To determine the factors associated and complications with the morbidity of patients with venous ulcers CEAP 6 in two health delivery systems in Colombia. Methodology: Observational study retrospective multicenter carried out in two health centers, one under the subsidized scheme and the other under the contributory scheme in patients captured adults over 18 years of age during the years 2018 and 2019 with a diagnosis of chronic venous insufficiency CEAP 6 performing a review to the clinical history up to 4 years before the consultation for vascular surgery of ulcerative pathology. Results: A total of 105 patients were evaluated 52% of the contributory regime and 48% patients of the subsidized regime. With 139 ulcers, 70% were women. The educational level of the population in 77% of the individuals had no schooling or only had primary education. The patients of the subsidized regime belonged to the low socioeconomic stratum vs the middle-class stratum in the contributory regime. 80.5% of the lesions are concentrated in groups less than 25 cm and 19.4% of the cases are located above 50 cm. Dressings and advanced technologies were used in 30.02% of the patients in the contributory scheme compared to 24.35% in the subsidized scheme. 37% of the subsidized scheme had contagion vs 28% of the contributory scheme. The epithelialization rates were 67.27% in the contributory regime compared to 26% in the subsidized regime. Conclusion: The prognostic factors that favor wound epithelialization are related to ulcers smaller than 25 cm, lesion evolution time under 36 months, having been managed with dressings and other advanced technologies, and belonging to the contributory regime.

Asunto(s)

RESUMEN

INTRODUCTION: Venous ulcers are the terminal phase of chronic venous insufficiency, the result of induced skin disorders and maintained by persistent venous hypertension. Affecting a large part of the adult population, they drain economic resources and greatly impact patient quality of life. OBJECTIVE: The objective of this descriptive, retrospective case series was to determine the efficacy of recombinant human epidermal growth factor (rhEGF) plus compression therapy vs standard of care in 48 patients with active ulcers resulting from chronic venous insufficiency. MATERIALS AND METHODS: In this descriptive, retrospective case series, 24 patients (mean age, 62.4 years) received rhEGF by intralesional and perilesional infiltration with compression therapy, and 24 patients (mean age, 69.4 years) received treatment with topical hydrocolloid gels and compression therapy. In 62.5% of patients, the ulcers were located in the internal malleoli. Ulcer progression time, ulcer size, Wollina score index, number of conventional cures, rhEGF vials used, and time to epithelialization were documented. RESULTS: Epithelialization of the active ulcer was reached in 100% of intervened patients. In the 24 patients receiving rhEGF, 71% achieved wound closure in 8 weeks or less, and the remaining percentage achieved closure within 9 and 12 weeks. In the conventional therapy group, patients achieved closure in an average of 29.5 weeks, with a minimum of 13 weeks and a maximum of 46 weeks. CONCLUSIONS: Although conventional therapy with the use of hydrocolloids and compression achieved adequate epithelialization of venous ulcers, the use of rhEGF significantly decreased healing time and could be a beneficial therapy to these patients who have few therapeutic options.

Asunto(s)

RESUMEN

OBJECTIVE: To determine the contribution of short femur diaphysis length (FDL) at 19-22 weeks of gestation in the prediction of adverse pregnancy outcomes. METHODS: The study included singleton pregnant women who underwent a routine anomaly scan at 19-22 weeks of gestation at the Virgen de la Arrixaca University Clinical Hospital (Murcia, Spain) between August 2011 and August 2012. Fetal biometry and Doppler ultrasound of uterine arteries were assessed as part of the anomaly scan, and the mean pulsatility index of both uterine arteries was recorded. Maternal obstetric characteristics, such as ethnicity, age, weight, parity, cigarette smoking, and medical history including hypertension and diabetes mellitus were collected from our database system. RESULTS: A total of 6,366 women were included in the study after excluding cases with abnormal karyotype, major fetal abnormalities, or termination of pregnancy. There were 88 cases of preeclampsia (PE) (1.4%). Logistic regression was performed including maternal and fetal characteristics. Short FDL at 19-22 weeks was significantly associated with subsequent development of PE (OR = 0.89, 95% CI: 0.80-0.99, p = 0.025). The best model to predict PE from our sample included gestational age at scan, parity, maternal weight, chronic hypertension, mean pulsatility index in the uterine arteries, and FDL (AUC = 0.78, 95% CI: 0.71-0.84). Regarding small for gestational age (SGA) neonates, there were also significant differences in FDL and FDL <5th centile between the control group and SGA newborns below the 3rd, 5th, and 10th centile. In the groups of preterm births (delivery before 32, 34, and 37 weeks), there were no differences in FDL compared with the control group (term births). DISCUSSION: Our results suggest that FDL at 19-22 weeks of gestation is an independent predictor of PE and SGA newborns.

Asunto(s)

RESUMEN

Background: There are a variety of instruments and indicators to assess continuity of care; however there is a lack of those that describe the result of coordination between the health care levels. Objective: To show two indicators that summarizes the result of the complete circuit primary level-secondary level-primary level. Methods: An observational prospective cohort study was conducted, with a one-year follow-up of a random sample of the references to general surgery services in a family medicine unit of the IMSS. Two indicators were analyzed: the outcome of the reference to general surgery, categorized as resolved, withdrawal and not resolved; and the time of solution of the surgical problem, which measures the median in calendar days from the issuance of the reference to the counter-reference for the reason of original sending. The indicators were compared by characteristics of the patient and the first level physician. Results: The 84.8% of cases were resolved in a median time of 72 days (50-112), 14.1% of patients reject surgery and 1% wasn´t resolved. No statistically significant differences were found according the evaluated characteristics. Conclusions: The overall solution time of the surgical problem in the medical unit is within the range built with previous studies, but in specific diagnoses there are significant variations. The frequency of solution of the surgical problem was high for diagnoses of greater risk.

Introducción: entre la gran variedad de instrumentos e indicadores para evaluar continuidad de la atención, escasean los que describen el resultado de la coordinación entre niveles de atención a la salud. Objetivo: mostrar dos indicadores que resumen el resultado del circuito completo primer nivel de atención-segundo nivel de atención-primer nivel de atención. Métodos: estudio observacional de cohorte prospectiva, con seguimiento a un año de una muestra aleatoria de las referencias realizadas por una unidad de primer nivel de atención a los servicios de cirugía general. Se analizaron dos indicadores: el desenlace de la referencia a cirugía general, categorizado como resuelto/abandono/no resuelto; y el tiempo de solución del problema quirúrgico, que mide la mediana en días naturales desde la emisión de la referencia hasta la contrarreferencia por el motivo de envío original. Se compararon los indicadores por características del paciente y del médico de primer nivel. Resultados: 84.8% de los casos se resolvió en un tiempo mediano de 72 días (rango de 50 a 112), 14.1% de los pacientes rechazaron la cirugía y 1% no se resolvió. No se encontraron diferencias estadísticamente significativas en las características analizadas. Conclusiones: el tiempo de solución global del problema quirúrgico en la unidad médica está dentro del rango construido con estudios previos, pero en diagnósticos específicos hay variaciones significativas. La frecuencia de solución del problema quirúrgico fue alta para diagnósticos de mayor riesgo.

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

Objetivo: desarrollar una guía de práctica clínica que permita orientar el diagnóstico de los pacientes con colitis ulcerativa mediante el uso adecuado de criterios clínicos y direccionar la conducta terapéutica en las diferentes etapas de la enfermedad y en los diferentes niveles de atención. Materiales y métodos: esta guía fue desarrollada por un equipo multidisciplinario con apoyo de la Asociación Colombiana de Gastroenterología, el Grupo Cochrane ITS y el Instituto de Investigaciones Clínicas de la Universidad Nacional de Colombia. Se desarrollaron preguntas clínicas relevantes a la entidad y se realizó la búsqueda de guías nacionales e internacionales en bases de datos especializadas. Las guías existentes fueron evaluadas en términos de calidad y aplicabilidad; una de las guías cumplió con los criterios de adaptación y el grupo decidió actualizar la búsqueda, desarrollando de novo las preguntas adicionales contempladas. El Grupo Cochrane realizó la búsqueda sistemática de la literatura. Las tablas de evidencia y recomendaciones fueron realizadas usando la metodología GRADE. Resultados: se desarrolló una guía de práctica clínica, basada en la evidencia, para el diagnóstico y tratamiento de la colitis ulcerativa en adultos en Colombia. Conclusiones: se estableció la importancia para el diagnóstico de la evaluación clínica, endoscópica e histológica y se especificaron las indicaciones para el adecuado tratamiento de los pacientes con colitis ulcerativa, de acuerdo con su severidad y estado de remisión.

Objective: To provide an evidence-based clinical practice guideline for the diagnostic and treatment of ulcerative colitis for patients, caregivers, administrative, and government bodies at all levels of care in Colombia. Materials and Methods: This guide was developed by a multidisciplinary team with the support of the Colombian Association of Gastroenterology, Cochrane STI Group and Clinical Research Institute of the Universidad Nacional de Colombia. Relevant clinical questions were developed and the search for national and international guidelines in databases was performed. Existing guidelines were evaluated for quality and applicability. One of the guidelines met the criteria for adaptation, so the group decided to update the search and develop de novo the additional questions. Systematic literature searches were conducted. The tables of evidence and recommendations were made based on the GRADE methodology. Results: An evidence-based Clinical Practice Guidelines for the management of ulcerative colitis was developed for the Colombian context. Conclusions: The opportune management of ulcerative colitis would have an impact of the disease in Colombia.

Asunto(s)

RESUMEN

OBJECTIVE: The objective of this study was to determine the contribution of uterine (UtA) and umbilical arteries (UA) Doppler examination at 28 weeks to predict adverse pregnancy outcomes in women who had increased resistance in UtA in the early second trimester. METHODS: Women with UtA mean pulsatility index (PI) above the 95th centile at 19-22 weeks of gestation were offered a growth scan including Doppler examination of UtA and UA at 28 weeks. Adverse pregnancy outcomes included small for gestational age (SGA), defined as birth weight below the tenth centile, preeclampsia (PE) and early-onset PE (PE before 34 weeks). RESULTS: We studied 266 pregnant women with elevated PI in the UtAs in the second trimester and ultrasound reassessment at 28 weeks. UtA PI >95th centile at 28 weeks was associated with subsequent PE [odds ratio (OR): 10.0, 95% CI: 2.3-43.5], early-onset PE (OR: 57.7, 95% CI: 3.8-87.6) and SGA less than the tenth centile (OR: 5.5, 2.2-13.9). UA PI >95th centile at 28 weeks was not significantly associated with any adverse outcome. CONCLUSIONS: In women with abnormal UtA Doppler in the early second trimester scan, persistence of elevated UtA PI, but not abnormal UA PI, is associated with adverse pregnancy outcomes including PE, early-onset PE and SGA. © 2014 John Wiley & Sons, Ltd.

Asunto(s)

RESUMEN

Las várices ectópicas (VE) en yeyuno son alteraciones vasculares infrecuentes, asociadas en mayor medida a la hipertensión portal (5%). Cuando se presenta sin esta asociación son aún menos frecuentes. Presentamos un caso de sangrado crónico intestinal de varios años, sin hipertensión portal proveniente de várices localizadas en yeyuno proximal, su curso clínico, los elementos de diagnóstico empleados y terapia quirúrgica.

Ectopic varices (EV) in the jejunum are a rare vascular disorder which is associated with portal hypertension (5%). It is even rarer when it occurs without associated portal hypertension. We report a case of a patient without portal hypertension who had had chronic intestinal bleeding from varices located in the proximal jejunum for several years. We report the patient’s clinical development, elements used for diagnosis and the surgical treatment.

Asunto(s)

RESUMEN

BACKGROUND AND AIMS: Diabetes represents a high epidemiological and economic burden worldwide. The cost of diabetes care increases slowly during early years, but it accelerates once chronic complications set in. There is evidence that adequate control may delay the onset of complications. Management of diabetes falls almost exclusively into primary care services until chronic complications appear. Therefore, primary care is strategic for reducing the expedited growth of costs. The objective of this study was to identify predictors of primary care costs in patients without complications in the years following diabetes diagnosis. METHODS: Direct medical costs for primary care were determined from the perspective of public health services provider. Information was obtained from medical records of 764 patients. Microcosting and average cost techniques were combined. A generalized linear regression model was developed including characteristics of patients and facilities. Primary health care costs for different patient profiles were estimated. RESULTS: The mean annual primary care cost was USD$465.1. Gender was the most important predictor followed by weight status, insulin use, respiratoty infections, glycemic control and dyslipidemia. A gap in costs was observed between genders; women make greater use of resources (42.1% on average). Such differences are reduced with obesity (18.1%), overweight (22.8%), respiratory infection (20.8%) and age >80 years (26.8%). Improving glycemic control shows increasing costs but at decreasing rates. CONCLUSIONS: Modifiable factors (glycemic control, weight status and comorbidities) drive primary care costs the first 10 years. Those factors had a larger effect in costs for males than in for females.

Asunto(s)

RESUMEN

La videocápsula endoscópica (VCE), se introdujo en Colombia en junio de 2003 como método diagnóstico de las enfermedades del intestino delgado; realizamos un estudio observacional, retrospectivo, descriptivo, con 100 pacientes referidos para la práctica de VCE. Objetivos. Presentar la experiencia clínica de la utilización de la VCE en nuestra población, determinar las indicaciones más frecuentes para el estudio del intestino delgado con VCE en nuestro país, definir las patologías encontradas en el grupo de pacientes estudiados, describir los hallazgos de videocápsula en relación a los síntomas de los pacientes. Metodología. Se realizó un análisis descriptivo de las variables identificadas y estudiadas, se analizó el comportamiento de los datos, se calcularon las medidas de tendencia central y de dispersión de las variables en mención. Resultados. En el 97% de los exámenes la indicación fue el estudio del sangrado digestivo oscuro oculto o manifiesto, la patología diagnosticada con mayor frecuencia fue la patología vascular (angiectasias) del intestino delgado, seguida por las patologías inflamatoria (úlceras), parasitaria y tumoral. Conclusiones. El examen de VCE es de gran ayuda en el estudio del sangrado digestivo oscuro ya sea oculto o manifiesto y debe considerarse en nuestro medio de primera elección luego de la realización de endoscopia digestiva alta con visualización de la segunda porción duodenal (2) y de colonoscopia con ileoscopia (2), si el paciente no presenta síntomas obstructivos.

The VCE was introduced in Colombia in June 2003 as a method to diagnose diseases in the small intestine. We ran comprehensive observations with a series of 100 cases and created a retrospective and descriptive study of patients referred to us for the practice of VCE. Objectives. To present the clinical experience in the use of the VCE in our population. To determine the most frequent findings for the study of the small intestine with VCE in our country. To define the pathologies found in the group of patients studied, describe the video capsule findings in relation to the symptoms. Methodology. We conducted a descriptive analysis of the identified and studied variables, looking at the behaviour of the data the central trend and dispersion of the variables was calculated. Results. In 97% of the cases, the indication was for the study of occult or overt obscure digestive bleeding. The most frequent diagnosed pathology was the vascular pathology (angiectasias) of the small intestine; followed by the inflammatory pathology (ulcers) with tumours and parasite. Conclusion. The video capsule endoscopy exam is of great help in the study of obscure digestive bleeding whether it is occult or overt. It should be considered in our country as the primary choice after the upper digestive endoscopy with visualisation of the second duodenal portion (2) and the colonoscopy with ileoscopy (2) if the patient doesn’t present obstructive symptoms.

Asunto(s)

RESUMEN

Introducción: la incidencia de eventraciones oscila entre uno y 16% de las laparotomías, convirtiendo la eventrorrafia en un procedimiento muy común en los servicios quirúrgicos. El National Nosocomial Infection Surveillance Systems NNISS, mostró que la infección del sitio operatorio (ISO) es la tercera infección nosocomial más frecuente en pacientes hospitalizados, con una prevalencia del 14 al 16%.' Son muchos los factores que se han relacionado con la ISO en eventrorrafias que a su vez se identifica como factor de riesgo para la recidiva de las eventraciones. Objetivo: describir la frecuencia de presentación de ISO y los factores relacionados, en pacientes a quienes se les realizó eventrorrafia. Metodología: estudio descriptivo de corte transversal en el período de julio 1 de 2004 y julio 1 de 2006 en el Hospital de San José. Se analizaron variables demográficas, quirúrgicas, las propias de la eventración y del posto-peratorio y las escalas de riesgo de infección. Resultados: de los 132 pacientes llevados a eventrorrafia, el 58.3% (77) fueron mujeres y 41.6% (55) hombres; el promedio de edad fue 50 años. La frecuencia de ISO global fue del 9% (12); la ISO superficial en diez casos (7.5%) y profunda en dos (1.5%). Los antecedentes patológicos identificados en la población con ISO fueron diabetes mellitus en 25%, enfermedad coronaria y EPOC en 8,3% y tabaquismo en 33%. En aquellos que no presentaron ISO se encontró 5%, 2,5%, 5.8% y 9% respectivamente. El tiempo promedio de cirugía fue 115 minutos en los pacientes con ISO y 86 minutos en aquellos sin ISO. El 33 % (4) con ISO requirió cirugía de urgencias por encarcelamiento. No se documentó ISO en los dos pacientes que requirieron resección intestinal. En los pacientes que no presentaron ISO, uno tuvo NNISS 3 y SENIC 4. Conclusiones: la frecuencia global de ISO y los factores de riesgo descritos en el estudio son similares a los reportes de la literatura médica. Se requiere de estudios futuros de tipo prospectivo con un adecuado seguimiento que permitan identificar factores de riesgo de ISO y hacer vigilancia sobre el comportamiento de la ISO secundaria a eventrorrafias en la institución.

Asunto(s)

RESUMEN

La presente investigación aplicada busca conocer los conceptos de desarrollo en docentes y padres de familia como actores en el proceso de la enseñanza- aprendizaje. Se utilizó un diseño descriptivo comparativo de tipo transversal, la naturaleza de la muestra fue no probabilística de tipo accidental y está constituida por docentes y padres de familia. Para fines de la investigación se elaboró una encuesta semi-estructurada, lo que permitió un análisis cuantitativo y cualitativo de resultados. Se encontró que ambos interlocutores de la educación ven al desarrollo como crecimiento, no obstante, éste es entendido de diferente manera por docentes y padres de familia. Asimismo, observamos diferencias en los tipos de expectativas que se tienen a nivel personal, familiar y social.

The present applied investigation intends to analyse the development concepts in educators and parents as actors in the teaching -learning process. The investigations design is comparative descriptive of traverse type, The nature of the sampling is of a non probabilistic, accidental type, integrated by educators and parents. A semi-structuredsurvey was elaborated, which allowed a quantitative and qualitative analysis of results. It was found that both actors of education consider the development as growth; nevertheless, this is understood in a different way by educational actors. Also, we observe differences in the types of expectations in personal, familiar and social levels.

Asunto(s)

RESUMEN

La presente investigación aplicada tiene por finalidad evaluar las percepciones de los beneficiarios de un programa de reinserción social dirigido a niños y adolescentes en situación de calle. El diseño es descriptivo, constituyendo una evaluación de programa formativa-proactiva-externa. La muestra está integrada por 20 menores con más de un mes de permanencia en la institución. Los dos instrumentos utilizados fueron cualitativos: una entrevista guiada y un grupo focal. Se encontró que el menor en situación de calle desea dejar el consumo de sustancias psicoactivas y reinsertarse a la sociedad por medio del trabajo. Atribuye este cambio a un esfuerzo personal (atribución interna) dejando en segundo lugar lo que la institución le pueda brindar; no obstante, pide que ésta sea un espacio integrado y de confianza mutua en donde se observen metas comunes y límites claros que beneficien la convivencia en comunidad.

An applied investigation was developed to evaluate the beneficiaries’ perception of social reinsertion program for children and adolescents in street situation. The design is a descriptive, formative, proactive and external type of program evaluation. The sample is integrated by 20 minors, all of them with more than a month of permanency in the institution. Both instruments were used qualitative: a guide interview and a focus group. It was found that the minor in street situation wants to leave drug’s consumption and to be reinserted into the society by means of his own work. He attributes this change to a personal effort (internal attribution), leaving in second place what the institution can offer him; nevertheless, they expect that the institution would provide an integrated space of mutual trust with common goals and clear limits that benefit the coexistence in community.

Asunto(s)

RESUMEN

Revisión de las características clínicas, aspectos genéticos y moleculares, epidemiología, factores del huésped y ambientales, síndromes hereditarios, prevención primaria y secundaria, seguimiento, estadificación y tratamiento del cáncer colorrectal

Asunto(s)

Asunto(s)

RESUMEN

El sistema APUD o sistema neuroendocrino difuso, se halla ampliamente distribuido por el organismo, con características morfológicas específicas, mecanismos de acción variados y diferentes orígenes embriológicos. Además de ser considerado como una tercera división del sistema nervioso, muy importante para el mantenimiento de la homeostasis, brinda un concepto que facilita la comprensión de numerosas enfermedades, para lograr, así, un certero diagnóstico clínico y anatomopatológico, y finalmente la aplicación de un tratamiento rápido y eficaz. Por la gran importancia del conocimiento de ese sistema, así como por la amplia aplicación clínica, se brindan sus principales aspectos clínicos y prácticos, para posibilitar la disminución de la morbilidad y la mortalidad. Constituye un reto para los científicos del mundo el uso de marcadores enzimáticos y de anticuerpos monoclonales para el diagnóstico y tratamiento de las enfermedades causadas por alteraciones en este sistema(AU)

Asunto(s)