Infecciones necrosantes de tejidos blandos en niños, experiencia en un hospital pediátrico
ilustraciones, gráficas, tablas
- Autores:
-
Ramírez Villamil , Andrés Guillermo
- Tipo de recurso:
- Fecha de publicación:
- 2022
- Institución:
- Universidad Nacional de Colombia
- Repositorio:
- Universidad Nacional de Colombia
- Idioma:
- spa
- OAI Identifier:
- oai:repositorio.unal.edu.co:unal/80917
- Palabra clave:
- 610 - Medicina y salud::618 - Ginecología, obstetricia, pediatría, geriatría
Infecciones de los Tejidos Blandos
Soft Tissue Infections
Children - surgery
Necrosis
Cirugía infantil
Necrosis
Infecciones necrosantes de tejidos blandos
Fascitis necrosante
Factores de riesgo
Microorganismos
Cirugía
Mortalidad
Necrotizing soft tissue infections
Necrotizing fasciitis
Risk factor's
Microorganism
Surgery
Mortality
- Rights
- openAccess
- License
- Reconocimiento 4.0 Internacional
id |
UNACIONAL2_c06a2e87f305da944e51ea393d64cdb9 |
---|---|
oai_identifier_str |
oai:repositorio.unal.edu.co:unal/80917 |
network_acronym_str |
UNACIONAL2 |
network_name_str |
Universidad Nacional de Colombia |
repository_id_str |
|
dc.title.spa.fl_str_mv |
Infecciones necrosantes de tejidos blandos en niños, experiencia en un hospital pediátrico |
dc.title.translated.eng.fl_str_mv |
Necrotizing soft tissue infections in children, experience in a pediatric hospital |
title |
Infecciones necrosantes de tejidos blandos en niños, experiencia en un hospital pediátrico |
spellingShingle |
Infecciones necrosantes de tejidos blandos en niños, experiencia en un hospital pediátrico 610 - Medicina y salud::618 - Ginecología, obstetricia, pediatría, geriatría Infecciones de los Tejidos Blandos Soft Tissue Infections Children - surgery Necrosis Cirugía infantil Necrosis Infecciones necrosantes de tejidos blandos Fascitis necrosante Factores de riesgo Microorganismos Cirugía Mortalidad Necrotizing soft tissue infections Necrotizing fasciitis Risk factor's Microorganism Surgery Mortality |
title_short |
Infecciones necrosantes de tejidos blandos en niños, experiencia en un hospital pediátrico |
title_full |
Infecciones necrosantes de tejidos blandos en niños, experiencia en un hospital pediátrico |
title_fullStr |
Infecciones necrosantes de tejidos blandos en niños, experiencia en un hospital pediátrico |
title_full_unstemmed |
Infecciones necrosantes de tejidos blandos en niños, experiencia en un hospital pediátrico |
title_sort |
Infecciones necrosantes de tejidos blandos en niños, experiencia en un hospital pediátrico |
dc.creator.fl_str_mv |
Ramírez Villamil , Andrés Guillermo |
dc.contributor.advisor.spa.fl_str_mv |
Molina Ramírez, Iván Darío |
dc.contributor.author.spa.fl_str_mv |
Ramírez Villamil , Andrés Guillermo |
dc.contributor.researchgroup.spa.fl_str_mv |
Unidad de Cirugía Pediátrica de la Universidad Nacional de Colombia |
dc.subject.ddc.spa.fl_str_mv |
610 - Medicina y salud::618 - Ginecología, obstetricia, pediatría, geriatría |
topic |
610 - Medicina y salud::618 - Ginecología, obstetricia, pediatría, geriatría Infecciones de los Tejidos Blandos Soft Tissue Infections Children - surgery Necrosis Cirugía infantil Necrosis Infecciones necrosantes de tejidos blandos Fascitis necrosante Factores de riesgo Microorganismos Cirugía Mortalidad Necrotizing soft tissue infections Necrotizing fasciitis Risk factor's Microorganism Surgery Mortality |
dc.subject.decs.spa.fl_str_mv |
Infecciones de los Tejidos Blandos |
dc.subject.decs.eng.fl_str_mv |
Soft Tissue Infections |
dc.subject.lemb.eng.fl_str_mv |
Children - surgery Necrosis |
dc.subject.lemb.spa.fl_str_mv |
Cirugía infantil Necrosis |
dc.subject.proposal.spa.fl_str_mv |
Infecciones necrosantes de tejidos blandos Fascitis necrosante Factores de riesgo Microorganismos Cirugía Mortalidad |
dc.subject.proposal.eng.fl_str_mv |
Necrotizing soft tissue infections Necrotizing fasciitis Risk factor's Microorganism Surgery Mortality |
description |
ilustraciones, gráficas, tablas |
publishDate |
2022 |
dc.date.accessioned.none.fl_str_mv |
2022-02-09T15:05:57Z |
dc.date.available.none.fl_str_mv |
2022-02-09T15:05:57Z |
dc.date.issued.none.fl_str_mv |
2022-01-21 |
dc.type.spa.fl_str_mv |
Trabajo de grado - Especialidad Médica |
dc.type.driver.spa.fl_str_mv |
info:eu-repo/semantics/masterThesis |
dc.type.version.spa.fl_str_mv |
info:eu-repo/semantics/acceptedVersion |
dc.type.content.spa.fl_str_mv |
Text |
dc.type.redcol.spa.fl_str_mv |
http://purl.org/redcol/resource_type/TM |
status_str |
acceptedVersion |
dc.identifier.uri.none.fl_str_mv |
https://repositorio.unal.edu.co/handle/unal/80917 |
dc.identifier.instname.spa.fl_str_mv |
Universidad Nacional de Colombia |
dc.identifier.reponame.spa.fl_str_mv |
Repositorio Institucional Universidad Nacional de Colombia |
dc.identifier.repourl.spa.fl_str_mv |
https://repositorio.unal.edu.co/ |
url |
https://repositorio.unal.edu.co/handle/unal/80917 https://repositorio.unal.edu.co/ |
identifier_str_mv |
Universidad Nacional de Colombia Repositorio Institucional Universidad Nacional de Colombia |
dc.language.iso.spa.fl_str_mv |
spa |
language |
spa |
dc.relation.indexed.spa.fl_str_mv |
Bireme |
dc.relation.references.spa.fl_str_mv |
Goldstein EJC, Anaya DA, Dellinger EP. Necrotizing Soft-Tissue Infection: Diagnosis and Management. Clin Infect Dis [Internet]. 2007 Mar 1;44(5):705–10. Available from: https://academic.oup.com/cid/article-lookup/doi/10.1086/511638 Zundel S, Lemaréchal A, Kaiser P, Szavay P. Diagnosis and Treatment of Pediatric Necrotizing Fasciitis: A Systematic Review of the Literature. Eur J Pediatr Surg [Internet]. 2016 Jul 5;27(02):127–37. Available from: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0036-1584531 Hussein QA, Anaya DA. Necrotizing Soft Tissue Infections. Crit Care Clin [Internet]. 2013 Oct;29(4):795–806. Available from: http://dx.doi.org/10.1016/j.ccc.2013.06.001 Stevens DL, Bryant AE. Necrotizing Soft-Tissue Infections. Longo DL, editor. N Engl J Med [Internet]. 2017 Dec 7;377(23):2253–65. Available from: http://www.nejm.org/doi/10.1056/NEJMra1600673 Fitzharris L. De matasanos a cirujanos. 1st ed. Barcelona: Penguin Random House Grupo Editorial; 2018. 315 p. Patiño JF, Castro D. Necrotizing lesions of soft tissues: A review. Vol. 15, World Journal of Surgery. 1991. Schroder A, Gerin A, Firth GB, Hoffmann KS, Grieve A, Von Sochaczewski CO. A systematic review of necrotising fasciitis in children from its first description in 1930 to 2018. BMC Infect Dis. 2019;19(1):1–13. Marques SA, Abbade LPF. Severe bacterial skin infections. An Bras Dermatol. 2020;95(4). Jamal N, Teach SJ. Necrotizing Fasciitis. Pediatr Emerg Care [Internet]. 2011 Dec;27(12):1195–9. Available from: http://journals.lww.com/00006565-201112000-00023 Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJC, Gorbach SL, et al. Executive Summary: Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America. Clin Infect Dis [Internet]. 2014 Jul 15;59(2):147–59. Available from: https://academic.oup.com/cid/article/59/2/147/442347 Valderrama-Beltrán S, Cortés JA, Caro MA, Cely-Andrado L, Osorio-Pinzón JV, Gualtero SM, et al. Guía de práctica clínica para el diagnóstico y manejo de las infecciones de piel y tejidos blandos en Colombia. Infectio [Internet]. 2019 Sep 9;23(4):318. Available from: http://revistainfectio.org/index.php/infectio/article/view/805 Chaudhry A, Gul M, Baker K, Elaine G. Imaging characterisits of soft tissue infections: Part 1. Contemp Diagnostic Radiol. 2015;38(15):1–5. Stevens DL, Bryant AE, Goldstein EJ. Necrotizing Soft Tissue Infections. Infect Dis Clin North Am [Internet]. 2021 Mar;35(1):135–55. Available from: https://doi.org/10.1016/j.idc.2020.10.004 Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJC, et al. Practice Guidelines for the Diagnosis and Management of Skin and Soft-Tissue Infections. Clin Infect Dis [Internet]. 2005 Nov 15;41(10):1373–406. Available from: https://academic.oup.com/cid/article/41/10/1373/345303 Tessier JM, Sanders J, Sartelli M, Ulrych J, De Simone B, Grabowski J, et al. Necrotizing Soft Tissue Infections: A Focused Review of Pathophysiology, Diagnosis, Operative Management, Antimicrobial Therapy, and Pediatrics. Surg Infect (Larchmt) [Internet]. 2020 Mar 1;21(2):81–93. Available from: https://www.liebertpub.com/doi/10.1089/sur.2019.219 Creta M, Sica A, Napolitano L, Celentano G, La Rocca R, Capece M, et al. Fournier’s Gangrene in Patients with Oncohematological Diseases: A Systematic Review of Published Cases. Healthcare [Internet]. 2021 Aug 30;9(9):1123. Dauger S, Blondé R, Brissaud O, Marcoux M-O, Angoulvant F, Levy M. Necrotizing soft-tissue infections in pediatric intensive care: a prospective multicenter case-series study. Crit Care [Internet]. 2021 Dec 12;25(1):139. Available from: https://ccforum.biomedcentral.com/articles/10.1186/s13054-021-03562-0 Hietbrink F, Bode LG, Riddez L, Leenen LPH, van Dijk MR. Triple diagnostics for early detection of ambivalent necrotizing fasciitis. World J Emerg Surg. 2016;11(1). Nawijn F, Hietbrink F, van Dijk MR. Getting it Right the First Time: Frozen Sections for Diagnosing Necrotizing Soft Tissue Infections. World J Surg. 2021;45(1). Lemaréchal A, Zundel S, Szavay P. Pediatric Necrotizing Fasciitis: Restitutio Ad Integrum after Early Diagnosis and Aggressive Surgical Treatment. Eur J Pediatr Surg Reports [Internet]. 2016 Dec 28;04(01):034–6. Available from: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0036-1594307 |
dc.rights.coar.fl_str_mv |
http://purl.org/coar/access_right/c_abf2 |
dc.rights.license.spa.fl_str_mv |
Reconocimiento 4.0 Internacional |
dc.rights.uri.spa.fl_str_mv |
http://creativecommons.org/licenses/by/4.0/ |
dc.rights.accessrights.spa.fl_str_mv |
info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Reconocimiento 4.0 Internacional http://creativecommons.org/licenses/by/4.0/ http://purl.org/coar/access_right/c_abf2 |
eu_rights_str_mv |
openAccess |
dc.format.extent.spa.fl_str_mv |
xv, 53 páginas |
dc.format.mimetype.spa.fl_str_mv |
application/pdf |
dc.publisher.spa.fl_str_mv |
Universidad Nacional de Colombia |
dc.publisher.program.spa.fl_str_mv |
Bogotá - Medicina - Especialidad en Cirugía Pediátrica |
dc.publisher.department.spa.fl_str_mv |
Departamento de Cirugía |
dc.publisher.faculty.spa.fl_str_mv |
Facultad de Medicina |
dc.publisher.place.spa.fl_str_mv |
Bogotá, Colombia |
dc.publisher.branch.spa.fl_str_mv |
Universidad Nacional de Colombia - Sede Bogotá |
institution |
Universidad Nacional de Colombia |
bitstream.url.fl_str_mv |
https://repositorio.unal.edu.co/bitstream/unal/80917/3/1032437535.2022.PDF https://repositorio.unal.edu.co/bitstream/unal/80917/4/license.txt https://repositorio.unal.edu.co/bitstream/unal/80917/5/1032437535.2022.PDF.jpg |
bitstream.checksum.fl_str_mv |
c403b5f554d915633a2bc6787644fe3d 8153f7789df02f0a4c9e079953658ab2 c6084bd7af7ac066acb392af4be381c2 |
bitstream.checksumAlgorithm.fl_str_mv |
MD5 MD5 MD5 |
repository.name.fl_str_mv |
Repositorio Institucional Universidad Nacional de Colombia |
repository.mail.fl_str_mv |
repositorio_nal@unal.edu.co |
_version_ |
1814089190205292544 |
spelling |
Reconocimiento 4.0 Internacionalhttp://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Molina Ramírez, Iván Darío3e4d8567b49484bedb4f935716f7e227Ramírez Villamil , Andrés Guillermo355ff5807e1d8a0ffe424f73ae53c17d600Unidad de Cirugía Pediátrica de la Universidad Nacional de Colombia2022-02-09T15:05:57Z2022-02-09T15:05:57Z2022-01-21https://repositorio.unal.edu.co/handle/unal/80917Universidad Nacional de ColombiaRepositorio Institucional Universidad Nacional de Colombiahttps://repositorio.unal.edu.co/ilustraciones, gráficas, tablasLas infecciones necrosantes de tejidos blandos son raras en población pediátrica, con morbilidad y mortalidad no concluyentes. En los últimos años hemos experimentado un aumento en los casos en el servicio de cirugía pediátrica de la Universidad Nacional de Colombia y la Fundación Hospital la Misericordia. El objetivo del presente estudio es caracterizar a la población con este tipo de infecciones que fue llevado a procedimientos quirúrgicos por nuestro servicio para entender el comportamiento en nuestro medio. Es un estudio descriptivo en el que se recolectaron un total de 52 pacientes entre enero de 2017 y diciembre de 2021 y se evaluaron variables demográficas, condiciones clínicas, intervenciones quirúrgicas y mortalidad. Los resultados muestran un promedio de edad de 8 años y predominancia del sexo femenino con 65,4%. Los factores de riesgo predominantes fueron neutropenia (71,1%) y leucemia linfoblástica aguda (74,1%). Los aislamientos microbiológicos mas encontrados fueron las enterobacterias con predominancia de la Escherichia coli (23%), Klebsiella pneumoniae (15,3%) y Pseudomonas aeruginosa (15,3%). Todos los pacientes fueron llevados a desbridamiento quirúrgico y 32,7% requirió colostomía. La localización más frecuente fue el periné con (59,6%) seguido por el abdomen (32,7%). Los síntomas tempranos estuvieron en el 88,5% y los tardíos en el 73,1% de la población. Finalmente, la mortalidad fue de 23,1%. El estudio muestra un comportamiento que difiere a lo registrado en la literatura con una alta mortalidad y variaciones en la presentación y los agentes infecciosos involucrados, probablemente en relación con los factores de riesgo de nuestra población. Se requieren estudios prospectivos con grupos control para evaluar el verdadero impacto. (Texto tomado de la fuente).Necrotizing soft tissue infections are rare in pediatric population, with inconclusive morbidity and mortality. In recent years, the pediatric surgery service at the National University of Colombia and the Fundación Hospital la Misericordia has experienced an increase in the cases. The objective of this study is to characterize the population with this type of infections that was taken to surgical procedures by our service to understand the behavior in our environment. It is a descriptive study in which a total of 52 patients were collected between January 2017 and December 2021; demographic variables, clinical conditions, surgical interventions and mortality were evaluated. The results show an average age of 8 years and a predominance of females with 65.4%. The predominant risk factors were neutropenia (71.1%) and acute lymphoblastic leukemia (74.1%). The microbiological isolates most found were Enterobacteriaceae with a predominance of Escherichia coli (23%), Klebsiella pneumoniae (15.3%) and Pseudomonas aeruginosa (15.3%). All patients underwent surgical debridement and 32.7% required colostomy. The most frequent location was the perineum (59.6%) followed by the abdomen (32.7%). Early symptoms were found in 88.5% and late symptoms in 73.1% of the population. Finally, mortality was 23.1%. The study shows a behavior that differs from that documented in the literature with high mortality and variations in the presentation and the infectious agents involved, probably in relation to the risk factors of our population. Prospective studies with control groups are required to assess the true impact.Especialidades MédicasEspecialista en Cirugía PediátricaCiencias médicas y de la saludxv, 53 páginasapplication/pdfspaUniversidad Nacional de ColombiaBogotá - Medicina - Especialidad en Cirugía PediátricaDepartamento de CirugíaFacultad de MedicinaBogotá, ColombiaUniversidad Nacional de Colombia - Sede Bogotá610 - Medicina y salud::618 - Ginecología, obstetricia, pediatría, geriatríaInfecciones de los Tejidos BlandosSoft Tissue InfectionsChildren - surgeryNecrosisCirugía infantilNecrosisInfecciones necrosantes de tejidos blandosFascitis necrosanteFactores de riesgoMicroorganismosCirugíaMortalidadNecrotizing soft tissue infectionsNecrotizing fasciitisRisk factor'sMicroorganismSurgeryMortalityInfecciones necrosantes de tejidos blandos en niños, experiencia en un hospital pediátricoNecrotizing soft tissue infections in children, experience in a pediatric hospitalTrabajo de grado - Especialidad Médicainfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/acceptedVersionTexthttp://purl.org/redcol/resource_type/TMBiremeGoldstein EJC, Anaya DA, Dellinger EP. Necrotizing Soft-Tissue Infection: Diagnosis and Management. Clin Infect Dis [Internet]. 2007 Mar 1;44(5):705–10. Available from: https://academic.oup.com/cid/article-lookup/doi/10.1086/511638Zundel S, Lemaréchal A, Kaiser P, Szavay P. Diagnosis and Treatment of Pediatric Necrotizing Fasciitis: A Systematic Review of the Literature. Eur J Pediatr Surg [Internet]. 2016 Jul 5;27(02):127–37. Available from: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0036-1584531Hussein QA, Anaya DA. Necrotizing Soft Tissue Infections. Crit Care Clin [Internet]. 2013 Oct;29(4):795–806. Available from: http://dx.doi.org/10.1016/j.ccc.2013.06.001Stevens DL, Bryant AE. Necrotizing Soft-Tissue Infections. Longo DL, editor. N Engl J Med [Internet]. 2017 Dec 7;377(23):2253–65. Available from: http://www.nejm.org/doi/10.1056/NEJMra1600673Fitzharris L. De matasanos a cirujanos. 1st ed. Barcelona: Penguin Random House Grupo Editorial; 2018. 315 p.Patiño JF, Castro D. Necrotizing lesions of soft tissues: A review. Vol. 15, World Journal of Surgery. 1991.Schroder A, Gerin A, Firth GB, Hoffmann KS, Grieve A, Von Sochaczewski CO. A systematic review of necrotising fasciitis in children from its first description in 1930 to 2018. BMC Infect Dis. 2019;19(1):1–13.Marques SA, Abbade LPF. Severe bacterial skin infections. An Bras Dermatol. 2020;95(4).Jamal N, Teach SJ. Necrotizing Fasciitis. Pediatr Emerg Care [Internet]. 2011 Dec;27(12):1195–9. Available from: http://journals.lww.com/00006565-201112000-00023Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJC, Gorbach SL, et al. Executive Summary: Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America. Clin Infect Dis [Internet]. 2014 Jul 15;59(2):147–59. Available from: https://academic.oup.com/cid/article/59/2/147/442347Valderrama-Beltrán S, Cortés JA, Caro MA, Cely-Andrado L, Osorio-Pinzón JV, Gualtero SM, et al. Guía de práctica clínica para el diagnóstico y manejo de las infecciones de piel y tejidos blandos en Colombia. Infectio [Internet]. 2019 Sep 9;23(4):318. Available from: http://revistainfectio.org/index.php/infectio/article/view/805Chaudhry A, Gul M, Baker K, Elaine G. Imaging characterisits of soft tissue infections: Part 1. Contemp Diagnostic Radiol. 2015;38(15):1–5.Stevens DL, Bryant AE, Goldstein EJ. Necrotizing Soft Tissue Infections. Infect Dis Clin North Am [Internet]. 2021 Mar;35(1):135–55. Available from: https://doi.org/10.1016/j.idc.2020.10.004Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJC, et al. Practice Guidelines for the Diagnosis and Management of Skin and Soft-Tissue Infections. Clin Infect Dis [Internet]. 2005 Nov 15;41(10):1373–406. Available from: https://academic.oup.com/cid/article/41/10/1373/345303Tessier JM, Sanders J, Sartelli M, Ulrych J, De Simone B, Grabowski J, et al. Necrotizing Soft Tissue Infections: A Focused Review of Pathophysiology, Diagnosis, Operative Management, Antimicrobial Therapy, and Pediatrics. Surg Infect (Larchmt) [Internet]. 2020 Mar 1;21(2):81–93. Available from: https://www.liebertpub.com/doi/10.1089/sur.2019.219Creta M, Sica A, Napolitano L, Celentano G, La Rocca R, Capece M, et al. Fournier’s Gangrene in Patients with Oncohematological Diseases: A Systematic Review of Published Cases. Healthcare [Internet]. 2021 Aug 30;9(9):1123.Dauger S, Blondé R, Brissaud O, Marcoux M-O, Angoulvant F, Levy M. Necrotizing soft-tissue infections in pediatric intensive care: a prospective multicenter case-series study. Crit Care [Internet]. 2021 Dec 12;25(1):139. Available from: https://ccforum.biomedcentral.com/articles/10.1186/s13054-021-03562-0Hietbrink F, Bode LG, Riddez L, Leenen LPH, van Dijk MR. Triple diagnostics for early detection of ambivalent necrotizing fasciitis. World J Emerg Surg. 2016;11(1).Nawijn F, Hietbrink F, van Dijk MR. Getting it Right the First Time: Frozen Sections for Diagnosing Necrotizing Soft Tissue Infections. World J Surg. 2021;45(1).Lemaréchal A, Zundel S, Szavay P. Pediatric Necrotizing Fasciitis: Restitutio Ad Integrum after Early Diagnosis and Aggressive Surgical Treatment. Eur J Pediatr Surg Reports [Internet]. 2016 Dec 28;04(01):034–6. Available from: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0036-1594307EstudiantesInvestigadoresMedios de comunicaciónResponsables políticosORIGINAL1032437535.2022.PDF1032437535.2022.PDFTesis de Especialidad en Cirugía Pediátricaapplication/pdf2778814https://repositorio.unal.edu.co/bitstream/unal/80917/3/1032437535.2022.PDFc403b5f554d915633a2bc6787644fe3dMD53LICENSElicense.txtlicense.txttext/plain; charset=utf-84074https://repositorio.unal.edu.co/bitstream/unal/80917/4/license.txt8153f7789df02f0a4c9e079953658ab2MD54THUMBNAIL1032437535.2022.PDF.jpg1032437535.2022.PDF.jpgGenerated Thumbnailimage/jpeg4605https://repositorio.unal.edu.co/bitstream/unal/80917/5/1032437535.2022.PDF.jpgc6084bd7af7ac066acb392af4be381c2MD55unal/80917oai:repositorio.unal.edu.co:unal/809172024-08-02 23:11:08.505Repositorio Institucional Universidad Nacional de Colombiarepositorio_nal@unal.edu.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 |