Rendimiento diagnóstico de las muestras de saliva para detectar SARS-CoV2: umbrella review

Introducción: Existe una necesidad clínica e investigativa en el campo de la salud relacionado con pruebas para la detección del virus SARS-Cov2. En la búsqueda, se pretende minimizar: protocolo de toma de muestra, costos e incomodidades de examen. Muestras de saliva, han sido protocolizadas, como m...

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Autores:
Zambrano Lehericith, Kelly Johana
Muegues Maestre, Hilda Rosa
Pérez Bonilla, Maria Fernanda
Tipo de recurso:
Trabajo de grado de pregrado
Fecha de publicación:
2021
Institución:
Universidad Santo Tomás
Repositorio:
Repositorio Institucional USTA
Idioma:
spa
OAI Identifier:
oai:repository.usta.edu.co:11634/38713
Acceso en línea:
http://hdl.handle.net/11634/38713
Palabra clave:
Saliva
SARS-CoV-2
COVID-19.
Diagnostic test
Saliva
Infecciones por coronavirus
Síndrome respiratorio agudo grave
Infecciones respiratorias
Diagnóstico virológico
Saliva
SARS-CoV-2
COVID-19.
Pruebas diagnósticas
Rights
openAccess
License
Abierto (Texto Completo)
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oai_identifier_str oai:repository.usta.edu.co:11634/38713
network_acronym_str SANTTOMAS2
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repository_id_str
dc.title.spa.fl_str_mv Rendimiento diagnóstico de las muestras de saliva para detectar SARS-CoV2: umbrella review
title Rendimiento diagnóstico de las muestras de saliva para detectar SARS-CoV2: umbrella review
spellingShingle Rendimiento diagnóstico de las muestras de saliva para detectar SARS-CoV2: umbrella review
Saliva
SARS-CoV-2
COVID-19.
Diagnostic test
Saliva
Infecciones por coronavirus
Síndrome respiratorio agudo grave
Infecciones respiratorias
Diagnóstico virológico
Saliva
SARS-CoV-2
COVID-19.
Pruebas diagnósticas
title_short Rendimiento diagnóstico de las muestras de saliva para detectar SARS-CoV2: umbrella review
title_full Rendimiento diagnóstico de las muestras de saliva para detectar SARS-CoV2: umbrella review
title_fullStr Rendimiento diagnóstico de las muestras de saliva para detectar SARS-CoV2: umbrella review
title_full_unstemmed Rendimiento diagnóstico de las muestras de saliva para detectar SARS-CoV2: umbrella review
title_sort Rendimiento diagnóstico de las muestras de saliva para detectar SARS-CoV2: umbrella review
dc.creator.fl_str_mv Zambrano Lehericith, Kelly Johana
Muegues Maestre, Hilda Rosa
Pérez Bonilla, Maria Fernanda
dc.contributor.advisor.none.fl_str_mv Martínez López, Carmen Alodia
dc.contributor.author.none.fl_str_mv Zambrano Lehericith, Kelly Johana
Muegues Maestre, Hilda Rosa
Pérez Bonilla, Maria Fernanda
dc.contributor.corporatename.spa.fl_str_mv Universidad Santo Tomás
dc.subject.keyword.spa.fl_str_mv Saliva
SARS-CoV-2
COVID-19.
Diagnostic test
topic Saliva
SARS-CoV-2
COVID-19.
Diagnostic test
Saliva
Infecciones por coronavirus
Síndrome respiratorio agudo grave
Infecciones respiratorias
Diagnóstico virológico
Saliva
SARS-CoV-2
COVID-19.
Pruebas diagnósticas
dc.subject.lemb.spa.fl_str_mv Saliva
Infecciones por coronavirus
Síndrome respiratorio agudo grave
Infecciones respiratorias
Diagnóstico virológico
dc.subject.proposal.spa.fl_str_mv Saliva
SARS-CoV-2
COVID-19.
Pruebas diagnósticas
description Introducción: Existe una necesidad clínica e investigativa en el campo de la salud relacionado con pruebas para la detección del virus SARS-Cov2. En la búsqueda, se pretende minimizar: protocolo de toma de muestra, costos e incomodidades de examen. Muestras de saliva, han sido protocolizadas, como medio diagnóstico para este fin. Objetivo: realizar un estudio tipo Umbrella Review para evaluar el rendimiento diagnóstico de las pruebas para determinar SARS-Cov2 por medio de saliva, así como también su efectividad clínica, siendo evaluada según la evidencia científica por medio de publicaciones de estudios tipo revisiones sistemáticas y metaanálisis. Materiales y métodos: Se ejecutó una exhaustiva búsqueda bibliográfica por medio de ecuaciones de búsqueda en las bases de datos PubMed, Embase, Scielo, Scopus y Google académico donde se consideraron publicaciones de los años 2020 y 2021. Inicialmente se recuperaron un total de 216 artículos y tras su filtrado, donde se tuvo en cuenta criterios de inclusión y exclusión como año de publicación, idioma y tema de interés quedaron 13 estudios recuperados para su respectivo análisis por medio de la aplicación de la lista de chequeo AMSTAR. Resultados: se obtuvo que las pruebas de detección del virus SARS-Cov2 por medio de muestras de saliva, tienen en promedio una sensibilidad que oscila entre un 80-97.7% (95% CI, 0.83–0.89) y una especificidad entre 95-97% (95% CI: 89.5–98.8). los valores de sensibilidad y especificidad de la prueba NPS y Saliva son relativamente similares para casos sintomáticos con alta carga viral y bastante aceptables para pacientes asintomáticos con baja carga viral Conclusión: Estos resultados, demostraron que las pruebas por medio de muestras de saliva tienen una alta precisión y efectividad diagnostica para la detección del virus SARS-Cov2 siempre y cuando sean pruebas de saliva con aclarado faríngeo
publishDate 2021
dc.date.accessioned.none.fl_str_mv 2021-12-14T16:56:53Z
dc.date.available.none.fl_str_mv 2021-12-14T16:56:53Z
dc.date.issued.none.fl_str_mv 2021-12-14
dc.type.none.fl_str_mv bachelor thesis
dc.type.local.spa.fl_str_mv Tesis de pregrado
dc.type.version.none.fl_str_mv info:eu-repo/semantics/acceptedVersion
dc.type.category.spa.fl_str_mv Formación de Recurso Humano para la Ctel: Trabajo de grado de Pregrado
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dc.type.drive.none.fl_str_mv info:eu-repo/semantics/bachelorThesis
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dc.identifier.citation.spa.fl_str_mv Zambrano, K,J, Muegues, H,R y Pérez,M,F (2021). Rendimiento diagnóstico de las muestras de saliva para detectar SARS-CoV2: umbrella review [Tesis de Pregrado] Universidad Santo Tomas, Bucaramanga, Colombia.
dc.identifier.uri.none.fl_str_mv http://hdl.handle.net/11634/38713
dc.identifier.reponame.spa.fl_str_mv reponame:Repositorio Institucional Universidad Santo Tomás
dc.identifier.instname.spa.fl_str_mv instname:Universidad Santo Tomás
dc.identifier.repourl.spa.fl_str_mv repourl:https://repository.usta.edu.co
identifier_str_mv Zambrano, K,J, Muegues, H,R y Pérez,M,F (2021). Rendimiento diagnóstico de las muestras de saliva para detectar SARS-CoV2: umbrella review [Tesis de Pregrado] Universidad Santo Tomas, Bucaramanga, Colombia.
reponame:Repositorio Institucional Universidad Santo Tomás
instname:Universidad Santo Tomás
repourl:https://repository.usta.edu.co
url http://hdl.handle.net/11634/38713
dc.language.iso.spa.fl_str_mv spa
language spa
dc.relation.references.spa.fl_str_mv Nunes LAS, Mussavira S, Bindhu OS. Clinical and diagnostic utility of saliva as a non-invasive diagnostic fluid: a systematic review. Biochemia medica 2015;25(2):177-192.
Li Y, Ren B, Peng X, Hu T, Li J, Gong T, et al. Saliva is a non‐negligible factor in the spread of COVID‐19. Molecular oral microbiology 2020 Aug;35(4):141-145.
Lima DP, Diniz DG, Moimaz SAS, Sumida DH, Okamoto AC. Saliva: reflection of the body. International journal of infectious diseases 2010;14(3):e184-e188.Chino para el Control y la Prevenci—n de Enferme-, dades el 7 de enero de 2020 siendo denominado, Coronavirus 2 del S'ndrome Respiratorio Agudo Se-, vero (SARS-CoV-2). Posteriormente, la enfermedad, fue nombrada COVID-19 por la Organizaci—n Mun-, dial de la Salud (OMS) (Singhal, 2020). Detecci—n de COVID -19 (SARS-CoV-2) Mediante la Saliva: Una Alternativa Diagn—stica poco Invasiva
Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English, Mandarin on the novel coronavirus COVID- 19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news, information website. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID- 19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website.
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Gustavo Barriga Angulo, Eva Aurora Hernández Sánchez. Utilidad de las muestras de saliva en el diagnóstico por el laboratorio
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Mcgill.ca. [citado el 22 de octubre de 2021]. Disponible en: https://www.mcgill.ca/oss/article/covid-19-health/when-negative-doesnt-really-meannegative-why-quality-matters-just-much-quantity-when-testing-covid
Sullivan PS, Sailey C, Guest JL, Guarner J, Kelley C, Siegler AJ, et al. Detection of SARSCoV-2 RNA and Antibodies in Diverse Samples: Protocol to Validate the Sufficiency of Provider-Observed, Home-Collected Blood, Saliva, and Oropharyngeal Samples. JMIR public health and surveillance 2020 Apr 24,;6(2):e19054
Byrne RL, Kay GA, Kontogianni K, Aljayyoussi G, Brown L, Collins AM, et al. Saliva Alternative to Upper Respiratory Swabs for SARS-CoV-2 Diagnosis. Emerging infectious diseases 2020 Nov;26(11):2770-2771
Hung K, Sun Y, Chen B, Lo J, Cheng C, Chen C, et al. New COVID-19 saliva-based test: How good is it compared with the current nasopharyngeal or throat swab test? Journal of the Chinese Medical Association 2020 Oct 1,;83(10):891-894
3. 2 COVID-19 serology at population scale: SARS-CoV-2-specific antibody responses in saliva
Czumbel LM, Kiss S, Farkas N, Mandel I, Hegyi A, Nagy Á, et al. Saliva as a Candidate for COVID-19 Diagnostic Testing: A Meta-Analysis. Frontiers in medicine 2020 Aug 4,;7:465.
Jasim H, Carlsson A, Hedenberg-Magnusson B, Ghafouri B, Ernberg M. Saliva as a medium to detect and measure biomarkers related to pain. Scientific reports 2018;8(1):3220-9.
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Melián-Rivas Andrés, Calcumil-Herrera Pablo, Boin-Bakit Camila, Carrasco-Soto Rolando. Detección de COVID -19 (SARS-CoV-2) Mediante la Saliva: Una Alternativa Diagnóstica poco Invasiva. Int. J. Odontostomat. [Internet]. 2020 Sep [citado 2020 Sep 28] ; 14( 3 ): 316-320.
Hernández Castañeda AA, Aranzazu Moya GC. CARACTERÍSTICAS Y PROPIEDADES FÍSICO-QUÍMICAS DE LA SALIVA: UNA REVISIÓN. UstaSalud 2012 Jul 1,;11(2):102.
Fakheran O, Dehghannejad M, Khademi A. Saliva as a diagnostic specimen for detection of SARS-CoV-2 in suspected patients: a scoping review. Infectious diseases of poverty 2020 Dec;9(1):1-100
Fernandes LL, Pacheco VB, Borges L, Athwal HK, de Paula Eduardo F, Bezinelli L, et al. Saliva in the Diagnosis of COVID-19: A Review and New Research Directions. Journal of dental research 2020 Sep 16,:2203452096007-22034520960070
Lippi G, Mattiuzzi C, Bovo C, Plebani M. Current laboratory diagnostics of coronavirus disease 2019 (COVID-19). Acta bio-medica : Atenei Parmensis 2020 May 11,;91(2):137- 145
Czumbel LM, Kiss S, Farkas N, Mandel I, Hegyi A, Nagy Á, et al. Saliva as a Candidate for COVID-19 Diagnostic Testing: A Meta-Analysis. Frontiers in medicine 2020 Aug 4,;7:465
Lisboa Bastos M, Tavaziva G, Abidi SK, Campbell JR, Haraoui L, Johnston JC, et al. Diagnostic accuracy of serological tests for covid-19: systematic review and meta-analysis. BMJ 2020 Jul 1,;370:m2516.
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McCormick-Baw C, Morgan K, Gaffney D, Cazares Y, Jaworski K, Byrd A, et al. Saliva as an Alternate Specimen Source for Detection of SARS-CoV-2 in Symptomatic Patients Using Cepheid Xpert Xpress SARS-CoV-2. Journal of clinical microbiology 2020 May 15,;58(8).
Vasseur P, Cossu C. Biomarkers and community indices as complementary tools for environmental safety. Environ. Int. 2003; 28(8): 711-717
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Swenberg JA, Fryar E, Jeong Y, Boysen G, Starr T, Walker VE, Albertini RJ. Biomarkers in Toxicology and Risk Assessment: Informing Critical Dose-Response Relationships. Chem Res Toxicol. 2008; 21(1): 253-265.
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Chen JH, Yip CC, Poon RW, Chan K, Cheng VC, Hung IF, et al. Evaluating the use of posterior oropharyngeal saliva in a point-of-care assay for the detection of SARS-CoV-2. Emerging microbes & infections 2020 Jan 1,;9(1):1356-1359
Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English, Mandarin on the novel coronavirus COVID- 19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news, information website. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID- 19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website.
Takeuchi Y, Furuchi M, Kamimoto A, Honda K, Matsumura H, Kobayashi R. Saliva-based PCR tests for SARS-CoV-2 detection. Journal of oral science 2020;62(3):350-351.
Torretta S, Zuccotti G, Cristofaro V, Ettori J, Solimeno L, Battilocchi L, et al. Nonserologic test for COVID‐19: How to manage? Head & neck 2020 Jul;42(7):1552-1554.
Aromataris E, Fernandez R, Godfrey C, Holly C, Kahlil H, Tungpunkom P. Methodology for JBI umbrella reviews. In Joanna Briggs Institute reviewer’s manual 2014. The Joanna Briggs Institute, Adelaide. http://joannabriggs.org/assets/ docs/sumari/ReviewersManualMethodology-JBI_Umbrella %20Reviews-2014.pdf
Khangura S, Konnyu K, Cushman R, Grimshaw J, Moher M. Evidence summaries: the evolution of a rapid review approach. Syst Rev 2012; 1: 10–8.
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Hartling L, Chisholm A, Thomson D, Dryden DM. A descriptive analysis of overviews of reviews published between 2000 and 2011. PLoS One 2012; 7: e49667.
Czumbel LM, Kiss S, Farkas N, Mandel I, Hegyi A, Nagy Á, et al. Saliva as a candidate for COVID-19 diagnostic testing: A meta-analysis. Front Med (Lausanne). 2020;7:465.
Fernandes LL, Pacheco VB, Borges L, Athwal HK, de Paula Eduardo F, Bezinelli L, et al. Saliva in the diagnosis of COVID-19: A review and new research directions. J Dent Res. 2020;99(13):1435–43.
Butler-Laporte G, Lawandi A, Schiller I, Yao M, Dendukuri N, McDonald EG, et al. Comparison of saliva and nasopharyngeal swab nucleic acid amplification testing for detection of SARS-CoV-2: A systematic review and meta-analysis: A systematic review and meta-analysis. JAMA Intern Med. 2021;181(3):353–60.
Bastos ML, Perlman-Arrow S, Menzies D, Campbell JR. The sensitivity and costs of testing for SARS-CoV-2 infection with saliva versus nasopharyngeal swabs : A systematic review and meta-analysis: A systematic review and meta-analysis. Ann Intern Med. 2021;174(4):501–10.
Böger B, Fachi MM, Vilhena RO, Cobre AF, Tonin FS, Pontarolo R. Systematic review with meta-analysis of the accuracy of diagnostic tests for COVID-19. Am J Infect Control. 2021;49(1):21–9
Cañete MG, Valenzuela IM, Garcés PC, Massó IC, González MJ, Providell SG. Saliva sample for the massive screening of SARS-CoV-2 infection: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2021;131(5):540–8.
Elkady DM, Abdella WS, Abdella M, Kopeya AE, Hamdallah A. Accuracy of SARS-CoV2 detection in saliva for COVID-19 diagnosis: A systematic review and meta-analysis. Frontiers in Emergency Medicine [Internet]. 2021; Disponible en: http://dx.doi.org/10.18502/fem.v5i4.6697
Khiabani K, Amirzade-Iranaq MH. Are saliva and deep throat sputum as reliable as common respiratory specimens for SARS-CoV-2 detection? A systematic review and meta-analysis. Am J Infect Control. 2021;49(9):1165–76.
Medeiros da Silva RC, Nogueira Marinho LC, de Araújo Silva DN, Costa de Lima K, Pirih FQ, Luz de Aquino Martins AR. Saliva as a possible tool for the SARS-CoV-2 detection: A review. Travel Med Infect Dis. 2020;38(101920):101920.
Nasiri K, Dimitrova A. Comparing saliva and nasopharyngeal swab specimens in the detection of COVID-19: A systematic review and meta-analysis. J Dent Sci. 2021;16(3):799–805.
Riccò M, Ranzieri S, Peruzzi S, Valente M, Marchesi F, Balzarini F, et al. RT-qPCR assays based on saliva rather than on nasopharyngeal swabs are possible but should be interpreted with caution: results from a systematic review and meta-analysis. Acta Biomed. 2020;91(3):e2020025.
Tsang NNY, So HC, Ng KY, Cowling BJ, Leung GM, Ip DKM. Diagnostic performance of different sampling approaches for SARS-CoV-2 RT-PCR testing: a systematic review and meta-analysis. Lancet Infect Dis. 2021;21(9):1233–45.
Sld.cu. [citado el 22 de octubre de 2021]. Disponible en: http://www.revestomatologia.sld.cu/index.php/est/article/view/3590/1891
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spelling Martínez López, Carmen AlodiaZambrano Lehericith, Kelly JohanaMuegues Maestre, Hilda RosaPérez Bonilla, Maria FernandaUniversidad Santo Tomás2021-12-14T16:56:53Z2021-12-14T16:56:53Z2021-12-14Zambrano, K,J, Muegues, H,R y Pérez,M,F (2021). Rendimiento diagnóstico de las muestras de saliva para detectar SARS-CoV2: umbrella review [Tesis de Pregrado] Universidad Santo Tomas, Bucaramanga, Colombia.http://hdl.handle.net/11634/38713reponame:Repositorio Institucional Universidad Santo Tomásinstname:Universidad Santo Tomásrepourl:https://repository.usta.edu.coIntroducción: Existe una necesidad clínica e investigativa en el campo de la salud relacionado con pruebas para la detección del virus SARS-Cov2. En la búsqueda, se pretende minimizar: protocolo de toma de muestra, costos e incomodidades de examen. Muestras de saliva, han sido protocolizadas, como medio diagnóstico para este fin. Objetivo: realizar un estudio tipo Umbrella Review para evaluar el rendimiento diagnóstico de las pruebas para determinar SARS-Cov2 por medio de saliva, así como también su efectividad clínica, siendo evaluada según la evidencia científica por medio de publicaciones de estudios tipo revisiones sistemáticas y metaanálisis. Materiales y métodos: Se ejecutó una exhaustiva búsqueda bibliográfica por medio de ecuaciones de búsqueda en las bases de datos PubMed, Embase, Scielo, Scopus y Google académico donde se consideraron publicaciones de los años 2020 y 2021. Inicialmente se recuperaron un total de 216 artículos y tras su filtrado, donde se tuvo en cuenta criterios de inclusión y exclusión como año de publicación, idioma y tema de interés quedaron 13 estudios recuperados para su respectivo análisis por medio de la aplicación de la lista de chequeo AMSTAR. Resultados: se obtuvo que las pruebas de detección del virus SARS-Cov2 por medio de muestras de saliva, tienen en promedio una sensibilidad que oscila entre un 80-97.7% (95% CI, 0.83–0.89) y una especificidad entre 95-97% (95% CI: 89.5–98.8). los valores de sensibilidad y especificidad de la prueba NPS y Saliva son relativamente similares para casos sintomáticos con alta carga viral y bastante aceptables para pacientes asintomáticos con baja carga viral Conclusión: Estos resultados, demostraron que las pruebas por medio de muestras de saliva tienen una alta precisión y efectividad diagnostica para la detección del virus SARS-Cov2 siempre y cuando sean pruebas de saliva con aclarado faríngeoThere is a clinical and research need in the health field for tests for the detection of the SARS-Cov2 virus. In the search, it is intended to minimize sampling protocol, examination costs and discomfort. Saliva samples have been protocolized as a diagnostic means for this purpose. Objective: to carry out an Umbrella Review type study to evaluate the diagnostic performance of the tests to determine SARS-Cov2 through saliva, as well as its clinical effectiveness, being evaluated according to scientific evidence through publications of studies such as systematic reviews and meta-analyzes. Materials and methods: An exhaustive bibliographic search was carried out using search equations in the PubMed, Embase, Scielo, Scopus and academic Google databases, where publications from the years 2020 and 2021 were considered. Initially, a total of 216 articles were retrieved. and after filtering, where inclusion and exclusion criteria were considered, such as year of publication, language, and topic of interest, 13 studies were retrieved for their respective analysis through the application of the AMSTAR checklist. Results: it was obtained that the SARS-Cov2 virus detection tests through saliva samples have an average sensitivity that ranges between 80-97.7% (95% CI, 0.83-0.89) and a specificity between 95-97 % (95% CI: 89.5–98.8). the sensitivity and specificity values ​​of the NPS and Saliva test are relatively similar for symptomatic cases with high viral load and quite acceptable for asymptomatic patients with low viral load. Conclusion: These results demonstrated that tests using saliva samples have a high diagnostic accuracy and effectiveness for the detection of the SARS-Cov2 virus if they are tests of saliva with pharyngeal rinsing.Odontólogohttp://www.ustabuca.edu.co/ustabmanga/presentacionPregradoapplication/pdfspaUniversidad Santo TomásPregrado OdontologíaFacultad de OdontologíaRendimiento diagnóstico de las muestras de saliva para detectar SARS-CoV2: umbrella reviewbachelor thesisTesis de pregradoinfo:eu-repo/semantics/acceptedVersionFormación de Recurso Humano para la Ctel: Trabajo de grado de Pregradohttp://purl.org/coar/resource_type/c_7a1finfo:eu-repo/semantics/bachelorThesisSalivaSARS-CoV-2COVID-19.Diagnostic testSalivaInfecciones por coronavirusSíndrome respiratorio agudo graveInfecciones respiratoriasDiagnóstico virológicoSalivaSARS-CoV-2COVID-19.Pruebas diagnósticasAbierto (Texto Completo)info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2CRAI-USTA BucaramangaNunes LAS, Mussavira S, Bindhu OS. 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Disponible en: http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S1019-43552021000200152ORIGINAL2021 PérezMaria.pdf2021 PérezMaria.pdfTrabajo de gradoapplication/pdf1487728https://repository.usta.edu.co/bitstream/11634/38713/8/2021%20P%c3%a9rezMaria.pdf395f834da3201e7eee9f3d4ffe402caeMD58open access2021 PérezMaria1.pdf2021 PérezMaria1.pdfAprobación de facultadapplication/pdf405799https://repository.usta.edu.co/bitstream/11634/38713/9/2021%20P%c3%a9rezMaria1.pdf3ad97b3ca145ec9a8592584172e58645MD59metadata only access2021 PérezMaria2.pdf2021 PérezMaria2.pdfAcuerdo de publicaciónapplication/pdf195125https://repository.usta.edu.co/bitstream/11634/38713/10/2021%20P%c3%a9rezMaria2.pdf868c40daa740cb328003ce757571250fMD510metadata only accessLICENSElicense.txtlicense.txttext/plain; charset=utf-8807https://repository.usta.edu.co/bitstream/11634/38713/11/license.txtaedeaf396fcd827b537c73d23464fc27MD511open accessTHUMBNAIL2021 PérezMaria.pdf.jpg2021 PérezMaria.pdf.jpgIM Thumbnailimage/jpeg4904https://repository.usta.edu.co/bitstream/11634/38713/12/2021%20P%c3%a9rezMaria.pdf.jpg38141d1f38857c87456a942456ffaca8MD512open access2021 PérezMaria1.pdf.jpg2021 PérezMaria1.pdf.jpgIM Thumbnailimage/jpeg8605https://repository.usta.edu.co/bitstream/11634/38713/13/2021%20P%c3%a9rezMaria1.pdf.jpge1a928516af43de16d7ff07fc8ece4b5MD513open access2021 PérezMaria2.pdf.jpg2021 PérezMaria2.pdf.jpgIM Thumbnailimage/jpeg10764https://repository.usta.edu.co/bitstream/11634/38713/14/2021%20P%c3%a9rezMaria2.pdf.jpg6a4ee363bfcc0fa7d780ca83987da1deMD514open access11634/38713oai:repository.usta.edu.co:11634/387132023-07-19 19:30:18.888metadata only accessRepositorio Universidad Santo Tomásnoreply@usta.edu.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