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Abstract This paper aims to assess the differences and associations of the effect of COVID-19 on sleep habits, sleep quality, and burnout symptoms among faculty members of higher education in Mexico. This was a cross-sectional study with a total sample of 214 faculty members of higher education from Mexico between May 18th and June 10th of 2020. We applied questionnaires containing sociodemographic and specific questions regarding sleep habits, sleep quality, and burnout symptoms. The results show that during COVID-19 faculty members delayed their bedtime and rise time. No change was found with weekdays time in bed, however, during weekends, time in bed was more than an hour shorter. Social jetlag decreased significantly during COVID-19. Furthermore, during COVID-19, those who reported low sleep quality were more likely to report higher symptoms of emotional exhaustion and those who slept less on weekends were more likely to report higher symptoms of depersonalization. These results suggest that the COVID-19 pandemic may have an effect on sleep and sleep quality and burnout symptoms of faculty members from higher education in Mexico.

Resumo Este trabalho visa avaliar as diferenças e associações do impacto da COVID-19 sobre hábitos de sono, qualidade do sono e sintomas de burnout entre os docentes de ensino superior no México. Trata-se de um estudo transversal, com amostra total de 214 docentes, realizado entre 18 de maio e 10 de junho de 2020. Foram aplicados questionários contendo questões sociodemográficas e específicas sobre hábitos de sono, qualidade do sono e sintomas de burnout. Os resultados mostram que durante a pandemia os docentes atrasaram a hora de dormir e acordar. Nenhuma alteração foi observada com relação ao tempo de semana na cama, porém nos finais de semana o tempo na cama era mais de uma hora menor. O jetlag social diminuiu significativamente durante a COVID-19. Além disso, durante a pandemia, aqueles que relataram baixa qualidade do sono eram mais propensos a relatar sintomas mais fortes de exaustão emocional, e aqueles que dormiam menos nos fins de semana eram mais propensos a relatar sintomas mais fortes de despersonalização. Esses resultados sugerem que a pandemia de COVID-19 pode ter um efeito sobre a qualidade do sono e causar sintomas de burnout nos integrantes do corpo docente do ensino superior no México.

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This paper aims to assess the differences and associations of the effect of COVID-19 on sleep habits, sleep quality, and burnout symptoms among faculty members of higher education in Mexico. This was a cross-sectional study with a total sample of 214 faculty members of higher education from Mexico between May 18th and June 10th of 2020. We applied questionnaires containing sociodemographic and specific questions regarding sleep habits, sleep quality, and burnout symptoms. The results show that during COVID-19 faculty members delayed their bedtime and rise time. No change was found with weekdays time in bed, however, during weekends, time in bed was more than an hour shorter. Social jetlag decreased significantly during COVID-19. Furthermore, during COVID-19, those who reported low sleep quality were more likely to report higher symptoms of emotional exhaustion and those who slept less on weekends were more likely to report higher symptoms of depersonalization. These results suggest that the COVID-19 pandemic may have an effect on sleep and sleep quality and burnout symptoms of faculty members from higher education in Mexico.

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The COVID-19 pandemic and the enforced restrictions have harshly affected educational sectors in 161 countries around the world. With more than 1.6 billion students away from normal school life, the crisis threatens the teaching and learning processes and the students' emotional health. Herein, we present the result of a careful assessment of the feelings of over 13,000 students at high school, undergraduate, and postgraduate levels across 36 campuses over 8 subsequent weeks from the onset of the COVID-19 pandemic. The results indicate a general low energy level and dominance of negative feelings among the students regardless of their academic levels. We have recorded 5 responses (being anxious, stressed, overwhelmed, tired, and depressed) as the most frequently reported feelings in the time of lockdown. Overall, 14% of those who have reported to suffer from these feelings have also identified a need for professional help in managing their feelings throughout the quarantine period. The current study also presents several strategies to combat the undesirable consequences of COVID-19 pandemic.

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This study examined the impact of the professors' gender according to a student evaluation of teaching (SET) in a private university. The study took place in a private university (n = 103,833) on six different campuses in the north region of Mexico. The distribution of the professors' gender was analyzed according to semesters, campuses, and schools. Our findings suggested that when undergraduates evaluated their professors on specific criteria concerning teaching performance, they expressed their opinion regardless of the professors' gender. However, when being asked for a single overall evaluation, as whether they would recommend the professor as one of their best professors, the students tended to favor male professors over their female peers by a slight margin. While such perceptions might not be representative of the actual teaching quality, it would be interesting in the future to delve deeper into the causes of possible biases.

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La hernia diafragmática congénita de presentación tardía (HDCT) es una entidad infrecuente, representa del 5 a 20 % de todos los casos de hernia diafragmática congénita. La presentación clínica, diagnóstico y tratamiento difiere de la hernia de presentación neonatal, dada la ausencia de hipoplasia e hipertensión pulmonar. El amplio espectro clínico de la presentación tardía o su hallazgo radiológico incidental, pueden plantear un desafío diagnóstico; la demora en su detección y abordaje aumentan la morbimortalidad y ensombrecen el pronóstico. Presentamos el caso de una escolar de 8 años de edad a quien se le diagnostica una hernia diafragmática congénita izquierda y se hace revisión del diagnóstico, tratamiento y pronóstico de la enfermedad.

The late-presenting congenital diaphragmatic hernia is a rare entity that corresponds to the 5 - 20% of all congenital diaphragmatic hernia cases. The clinical manifestations ,diagnosis and treatment differ from the neonatal presentation in the absence of pulmonary hypoplasia and pulmonary hypertension. The wide clinical spectrum of the late-presenting diaphragmatic hernia or its incidental finding on radiological images can lead to a challenging diagnosis. The delay in the detection and approach increases the morbidity and mortality, and darkens the prognosis. We are presenting a case of an eighth year-old scholar who is diagnosed with a congenital left diaphragmatic hernia, as well as a review of the diagnosis, treatment and prognosis of this pathology.

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BACKGROUND: Asthma is a common disease in the world and vitamin D (Vit-D) has been associated with the presence and severity of this disease. OBJECTIVE: To establish the association between levels of Vit-D and IgE response in schoolchildren with asthma living in four cities in Colombia. METHODS: Case-control study in 1340 schoolchildren (687 asthmatic and 653 controls) from communities in extreme poverty in Barranquilla, Cartagena, Santa Marta, and Montería. Serum concentrations of Vit-D, total IgE, and anti-Dermatophagoides farinae, Periplaneta americana, and Ascaris lumbricoides (AL) specific IgE were measured. RESULTS: Controls reported higher concentrations of Vit-D [61.9 ± 28.4 ng/mL] than cases [53 ± 23.3 ng / mL] (p < 0.05). Total IgE was higher in cases (p < 0.05). Only anti-AL IgE showed a clear difference: in controls, optical density was 0.27 ± 0.25; in cases, 0.22 ± 0.24 (p < 0.05). Vit-D showed differences between cases and controls in each population. CONCLUSIONS: An association could not be demonstrated between Vit-D deficiency and asthma, as total IgE was elevated in patients and controls. The results suggest that Vit-D influences the specif IgE response in poor asthmatic children in areas endemic for helminthiasis.

Antecedentes: El asma es una enfermedad frecuente en el mundo y la vitamina D (Vit-D) se ha asociado con la presencia y severidad de esta enfermedad. Objetivo: Establecer la asociación entre los niveles de Vit-D y la respuesta IgE en escolares con asma residentes de cuatro ciudades colombiananas. Métodos: Estudio de casos y controles en 1340 escolares (687 asmáticos y 653 controles) de comunidades en extrema pobreza de Barranquilla, Cartagena, Santa Marta y Montería. Se midieron las concentraciones séricas de Vit-D, IgE total e IgE específica anti Dermatofagoides farinae, Periplaneta americana y Ascaris lumbricoides (AL). Resultados: Los controles reportaron concentraciones mayores de Vit-D [61.9 ± 28.4 ng/mL] que los casos [53 ± 23.3 ng/mL] (p<0.05). La IgE total fue mayor en los casos (p<0.05). Solo IgE anti-AL mostró una diferencia clara: controles, densidad óptica 0.27 ± 0.25; casos 0.22 ± 0.24 (p<0.05). La Vit-D presentó diferencias entre casos y controles en cada población. Conclusiones: No se pudo demostrar la asociación entre deficiencia de Vit-D y asma, dado que la IgE total estuvo elevada en los pacientes y en los controles. Los resultados sugieren que la Vit-D influye en la respuesta IgE específica en niños asmáticos pobres en zonas endémicas para helmintiasis.

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Gluconacetobacter diazotrophicus is a N2-fixing bacterium endophyte from sugar cane. The oxidation of ethanol to acetic acid of this organism takes place in the periplasmic space, and this reaction is catalyzed by two membrane-bound enzymes complexes: the alcohol dehydrogenase (ADH) and the aldehyde dehydrogenase (ALDH). We present strong evidence showing that the well-known membrane-bound Alcohol dehydrogenase (ADHa) of Ga. diazotrophicus is indeed a double function enzyme, which is able to use primary alcohols (C2-C6) and its respective aldehydes as alternate substrates. Moreover, the enzyme utilizes ethanol as a substrate in a reaction mechanism where this is subjected to a two-step oxidation process to produce acetic acid without releasing the acetaldehyde intermediary to the media. Moreover, we propose a mechanism that, under physiological conditions, might permit a massive conversion of ethanol to acetic acid, as usually occurs in the acetic acid bacteria, but without the transient accumulation of the highly toxic acetaldehyde.

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Acetic acid bacteria oxidize a great number of substrates, such as alcohols and sugars, using different enzymes that are anchored to the membrane. In particular, Gluconacetobacter diazotrophicus is distinguished for its N2-fixing activity under high-aeration conditions. Ga. diazotrophicus is a true endophyte that also has membrane-bound enzymes to oxidize sugars and alcohols. Here we reported the purification and characterization of the membrane-bound glucose dehydrogenase (GDHm), an oxidoreductase of Ga. diazotrophicus. GDHm was solubilized and purified by chromatographic methods. Purified GDHm was monomeric, with a molecular mass of 86 kDa. We identified the prosthetic group as pyrroloquinoline quinone, whose redox state was reduced. GDHm showed an optimum pH of 7.2, and its isoelectric point was 6.0. This enzyme preferentially oxidized D-glucose, 2-deoxy-D-glucose, D-galactose and D-xylose; its affinity towards glucose was ten times greater than that of E. coli GDHm. Finally, Ga. diazotrophicus GDHm was capable of reducing quinones such as Q 1, Q 2, and decylubiquinone; this activity was entirely abolished in the presence of micromolar concentrations of the inhibitor, myxothiazol. Hence, our purification method yielded a highly purified GDHm whose molecular and kinetic parameters were determined. The possible implications of GDHm activity in the mechanism for reducing competitor microorganisms, as well as its participation in the respiratory system of Ga. diazotrophicus, are discussed.

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O objetivo do estudo foi descrever a magnitude e a distribuição da mortalidade por homicídios nas Américas e analisar suas tendências. Foram analisados óbitos por homicídios (X85 a Y09 e Y35) de 32 países das Américas, período 1999-2009, registrados no Sistema de Informações de Mortalidade/Organização Pan Americana da Saúde. Utilizou-se modelo binomial negativo para estudar as tendências. Cerca de 121.297 mortes por homicídios (89% homens e 11% mulheres) ocorreram anualmente nas Américas, predominando as idades de 15 a 24 e de 25 a 39 anos. Em 2009, a taxa padronizada de homicídios da região foi 15,5/100.000. Os países com taxas/100.000 baixas foram Canadá (1,8), Argentina (4,4), Cuba (4,8), Chile (5,2) e Estados Unidos (5,8); e com taxas/100.000 altas foram El Salvador (62,9), Guatemala (51,2), Colômbia (42,5), Venezuela (33,2) e Porto Rico (25,8). Entre 1999-2009 as taxas da região permaneceram estáveis; aumentaram em nove países, como Venezuela (p < 0,001), Panamá (p < 0,001), El Salvador (p < 0,001) e Porto Rico (p < 0,001); diminuíram em quatro países, especialmente na Colômbia (p < 0,001); e permaneceram estáveis no Brasil, Estados Unidos, Equador e Chile. O aumento no México ocorreu no período mais recente. Apesar dos esforços empreendidos, diversos países têm taxas altas de homicídios e crescimento nas mesmas.

The scope of this study was to describe the magnitude and distribution of deaths by homicide in the Americas and to analyze the prevailing trends. Deaths by homicide (X85 to Y09 and Y35) were analyzed in 32 countries of the Americas Region from 1999 to 2009, recorded in the Mortality Information System/Pan American Health Organization. A negative binomial model was used to study the trends. There were around 121,297 homicides (89% men and 11% women) in the Americas, annually, predominantly in the 15 to 24 and 25 to 39 year age brackets. In 2009 the homicide age-adjusted mortality rate was 15.5/100,000 in the region. Countries with lower rates/100,000 were Canada (1.8), Argentina (4.4), Cuba (4.8), Chile (5.2), and the United States (5.8), whereas the highest rates/100,000 were in El Salvador (62.9), Guatemala (51.2), Colombia (42.5), Venezuela (33.2), and Puerto Rico (25.8). From 1999-2009, the homicide trend in the region was stable. They increased in nine countries: Venezuela (p<0.001), Panama (p<0.001), El Salvador (p<0.001), Puerto Rico (p<0.001); decreased in four countries, particularly in Colombia (p<0.001); and were stable in Brazil, the United States, Ecuador and Chile. The increase in Mexico occurred in recent years. Despite all efforts, various countries have high homicide rates and they are on the increase.

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The scope of this study was to describe the magnitude and distribution of deaths by homicide in the Americas and to analyze the prevailing trends. Deaths by homicide (X85 to Y09 and Y35) were analyzed in 32 countries of the Americas Region from 1999 to 2009, recorded in the Mortality Information System/Pan American Health Organization. A negative binomial model was used to study the trends. There were around 121,297 homicides (89% men and 11% women) in the Americas, annually, predominantly in the 15 to 24 and 25 to 39 year age brackets. In 2009 the homicide age-adjusted mortality rate was 15.5/100,000 in the region. Countries with lower rates/100,000 were Canada (1.8), Argentina (4.4), Cuba (4.8), Chile (5.2), and the United States (5.8), whereas the highest rates/100,000 were in El Salvador (62.9), Guatemala (51.2), Colombia (42.5), Venezuela (33.2), and Puerto Rico (25.8). From 1999-2009, the homicide trend in the region was stable. They increased in nine countries: Venezuela (p<0.001), Panama (p<0.001), El Salvador (p<0.001), Puerto Rico (p<0.001); decreased in four countries, particularly in Colombia (p<0.001); and were stable in Brazil, the United States, Ecuador and Chile. The increase in Mexico occurred in recent years. Despite all efforts, various countries have high homicide rates and they are on the increase.

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PURPOSE: Paragangliomas of the head and neck are neuroendocrine tumors and are associated with germ line mutations of the tricarboxylic acid cycle-related genes SDHB, SDHC, SDHD, and SDHAF2. Hypoxia is important in most solid tumors, and was directly implicated in tumorigenesis over 40 years ago when it was shown that dwelling at high altitudes increases the incidence of carotid body hyperplasia and paragangliomas. Although recent research has now elucidated several pathways of hypoxia in paragangliomas, nothing is currently known of the genetics or of gene-environment interactions in high-altitude paraganglioma. We postulated that SDH mutations might play a role in these tumors. EXPERIMENTAL DESIGN: Patients from a Mexican family, originating and resident in Guadalajara, were tested for mutations of SDHD, and subsequently, for mutations of SDHB followed by immunohistochemical confirmation of SDHB loss. RESULTS: Two patients, born and resident at altitudes of between 1,560 and 2,240 m, were found to have head and neck paragangliomas, including a remarkably aggressive recurrent tumor. Mutation analysis identified a pathogenic missense mutation in exon 7 of SDHB, c.689G>A, p.Arg230His, and loss of the SDHB protein was confirmed by immunohistochemistry. CONCLUSIONS: This is the first report of a SDH gene mutation in paraganglioma at high altitude. A rapidly recurrent head and neck paraganglioma is a very rare finding in an SDH mutation carrier, suggesting a gene-environment interaction. Neither patient showed evidence of sympathetic paraganglioma.

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We have characterized an experimental model of ethanol-induced chronic gastritis in which a compensatory mucosal cell proliferation is apparently regulated by lipoperoxidative events. Therefore, the present study is an attempt to further assess the participation of oxidant stress during gastric mucosa proliferation, by administering alpha-tocopherol (vitamin E) to rats with gastritis. A morphometric analysis was done, and parameters indicative of oxidant stress, cellular proliferation (including cyclin D1 levels), apoptotic events, and activities of endogenous antioxidant systems were measured in gastric mucosa from our experimental groups. After ethanol withdrawal, restitution of surface epithelium coincided with increased lipid peroxidation and cell proliferation and further active apoptosis. High alpha-tocopherol dosing (100 IU/kg bw) showed a clear antioxidant effect, abolished cell proliferation, and promoted an early and progressive apoptosis, despite vitamin E also enhancing levels of endogenous antioxidants. Indicators of cell proliferation inversely correlated with apoptotic events, and this relationship was blunted by administering vitamin E, probably by affecting translocation of active cyclin D1 into the nucleus. In conclusion, alpha-tocopherol administration inhibited cell proliferation, leading to a predominance of apoptotic events in ethanol-induced gastric damage. Therefore, the timing and magnitude of lipoperoxidative events seemed to synchronize in vivo cell proliferative and apoptotic events, probably by changing the cell redox state.

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El ambiente microbiológico oral es único y tiene una dinámica compleja. Se calcula que cerca de 500 especies de bacterias habitan la cavidad oral humana, y alrededor de 22 géneros son los predominantes. Las bacterias que se aíslan con más frecuencia de los sitios infectados de la cavidad oral, y que son también patógenos potenciales, forma un grupo pequeño de microorganismos gramnegativos, entre los que se incluyen los siguientes: Actinobacillus actinomycetemcomitans, Bacteroides forsythus, Campylobacter spp., Capnocytophoga spp., Eikenella corrodens, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia y el grupo-Streptococcus milleri. E. corrodens se reconoce como un microbio patógeno oportunista en la cavidad oral; también, puede causar infecciones extra orales, como un agente infeccioso solo o en combinaciones con diversas bacterias. La presente revisión, con un énfasis en E. corrodens, mostrará varios aspectos de sus características microbiológicas y bioquímicas, también se sistematizan y discuten el conocimiento actual sobre los mecanismos de patogénesis, como los lipopolisacáridos, proteínas externas de membrana, complejo de adesina, pili y otros; infecciones oral y extra oral; factores predisponentes; endocarditis; osteomielitis, infecciones intra-abdominales; diagnóstico y agentes antimicrobianos.

The oral microbiological environment is unique and has a complex dynamic. It has been estimated that about 500 species of bacteria inhabit the human oral cavity and about 22 genera of them are the most dominant. The most frequently isolated from infected pockets of the oral cavity bacteria which are also potential pathogens form a small group of gramnegative microorganisms among which are included the following: Actinobacillus actinomycetemcomitans, Bacteroides forsythus, Campylobacter spp., Capnocytophoga spp., Eikenella corrodens, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, and Streptococcus milleri-group. E. corrodens is distinguished for being an opportunistic oral pathogen. It can also produce extra-oral infections acting either as an infectious agent itself or together with other bacteria. Referring to E. corrodens the present review will not only demonstrate different aspects about microbiological and biochemical characteristics, but also the actual knowledge on pathogenesis mechanism, like polysaccharides, outer membrane protein, lectin-like adhesin complex, pili, and other mechanisms will be systematized and discussed. Oral and extra-oral infections and other risking factors like endocarditis; osteomyelitis, intra-abdominal infections, their diagnosis and antimicrobial agents will be also considered in this paper.

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O Grupo Temático de Saúde e Ambiente da Associação Brasileira de Pós-Graduação em Saúde Coletiva – ABRASCO – elaborou subsídios para um Plano Diretor de Saúde e Ambiente no Âmbito do Sistema Único de Saúde, na perspectiva de se estabelecer uma política intersetorial nesse tema. O presente artigo traz esta contribuição do grupo, abordando aspectos conceituais e operacionais, fruto de vários debates interdisciplinares ocorridos em diversas oficinas e consolidado em uma Oficina de Trabalho deste GT realizada em Brasília, no ano de 2003, durante o Congresso Brasileiro de Saúde Coletiva.

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A novel bo3-type quinol oxidase was highly purified from Bacillus cereus PYM1, a spontaneous mutant unable to synthesize heme A and therefore spectroscopically detectable cytochromes aa3 and caa3. The purified enzyme contained 12.4 nmol of heme O and 11.5 nmol of heme B mg-1 protein. The enzyme was composed of two subunits with an Mr of 51,000 and 30,000, respectively. Both subunits were immunoreactive to antibodies raised against the B cereus aa3 oxidase. Moreover, amino-terminal sequence analysis of the 30-kDa subunit revealed that the first 19 residues were identical to those from the 30-kDa subunit of the B. cereus aa3 oxidase. The purified bo3 oxidase failed to oxidize ferrrocytochrome c (neither yeast nor horse) but oxidized tetrachlorohydroquinol with an apparent Km of 498 microM, a Vmax of 21 micromol of O2 min-1mg-1, and a calculated turnover of 55 s-1. The quinol oxidase activity with tetrachlorohydroquinol was inhibited by potassium cyanide and 2-n-heptyl 4-hydroxyquinoline-N-oxide with an I50 of 24 and 300 microM, respectively. Our results demonstrate that the bo3 oxidase of this mutant is not the product of a new operon but instead is a cytochrome aa3 apoprotein encoded by the qox operon of the aa3 oxidase of B. cereus wild type promiscuously assembled with hemes B and O replacing heme A, producing a novel bo3 cytochrome. This is the first reported example of an enzymatically active promiscuous oxidase resulting from the simultaneous substitution of its original hemes in the high and low spin sites.

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La importancia del absceso pulmonar en niños ha disminuido ostensiblemente desde el advenimiento de los antibióticos. A pesar de ello, en grupos especiales de pacientes en un problema relativamente frecuente e importante por sus potenciales complicaciones y secuelas. Los abordajes de la patología en la literatura son infrecuentes y se trata en general de series retrospectivas con datos epidemiológicos incompletos. El tratamiento de elección es terapeútica antibiótica conservadora de larga duración. Las técnicas de aspiración percutáneas mínimamente invasivas han relegado los abordajes quirúrgicos. Sólo la presencia de abscesos grandes y con la inminencia de ruptura y estados toxoinfeciosos severos obligarían a intervenciones invasivas tempranas. El pronóstico global del absceso pulmonar primario es excelente cuando el tratamiento adecuado es instaurado oportunamente

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En un estudio retrospectivo revisamos 49 casos de ahogamiento en niños presentados en la ciudad y playas de Cartagena entre Enero de 1994 y Diciembre de 1995. Evaluamos por un lado el perfil epidemiológico de la población afectada y por el otro el tratamiento de emergencia administrado a los pacientes. Se presentaron 49 casos en un periodo de 24 meses lo que significa un paciente cada 2 semanas. la edad promedio fue de 7.9 años, siendo el grupo escolar el más afectado; destacamos sin embargo la presencia de 9 pacientes por debajo de 2 años de edad. Aunque Cartagena es un importante centro centro turistico, alrededor de tres cuartas partes de los pacientes eran habitantes de la ciudad. En relación con el tratamiento encontramos una utilización frecuentemente inadecuada de antibioticos, diureticos y corticoides. La incidencia de casi ahogamiento en la población de Cartagena es alta, constituyendose en un problema de salud pública. Las medidas preventivas deben ser mejoradas para evitar esta clase de accidentes

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En un estudio retrospectivo revisamos 49 casos de ahogamiento en niños presentados en la ciudad y playas de Cartagena entre enero de 1994 y diciembre de 1995. Evaluamos por un lado el perfil epidemiológico de la población afectada y por otro lado el tratamiento de emergencia administrado a los pacientes. Se presentaron 49 casos en un período de 24 meses lo que significa un paciente cada 2 semanas. La edad promedio fue de 7.9 años siendo el grupo escolar el más afectado; destacamos, sin embargo la presencia de 99 pacientes por debajo de 2 años de edad. Aunque Cartagena es un importante centro turístico, alrededor de 3/4 partes de los pacientes eran habitantes de la ciudad. En relación con el tratamiento encontramos una utilización frecuentemente inadecuada de antibióticos, diuréticos y corticoides. La incidencia de casi ahogamiento en la población de Cartagena es alta constituyéndose en un problema de salud pública. Las medidas preventivas deben ser mejoradas para evitar esta clase de accidentes

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La fibrosis quística (FQ), la enfermedad autosómica recesiva más frecuente en poblaciones caucásicas, tiene una incidencia promedio de 1/2.500 recién nacidos

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