Revisión sistemática: análisis de la terapia osteopática en la tendinitis del manguito rotador

ilustraciones, diagrama

Autores:
Camacho Sanchez, Yely Alexandra
Tipo de recurso:
Fecha de publicación:
2023
Institución:
Universidad Nacional de Colombia
Repositorio:
Universidad Nacional de Colombia
Idioma:
spa
OAI Identifier:
oai:repositorio.unal.edu.co:unal/84969
Acceso en línea:
https://repositorio.unal.edu.co/handle/unal/84969
https://repositorio.unal.edu.co/
Palabra clave:
610 - Medicina y salud
Lesiones del maguito de los rotadores
Rotator Cuff Injuries
Tendinopatía
Tendinopathy
Tendinitis
Manguito rotador
Revision sistematica
Osteopatía
Systematic review
Tendonitis
Rotator cuff
Osteopathy
Manual therapy
Chiropractic
Musculoskeletal
Manipulation
Rights
openAccess
License
Atribución-NoComercial 4.0 Internacional
id UNACIONAL2_d6f46de8de305290b4cfc2af6a297dae
oai_identifier_str oai:repositorio.unal.edu.co:unal/84969
network_acronym_str UNACIONAL2
network_name_str Universidad Nacional de Colombia
repository_id_str
dc.title.spa.fl_str_mv Revisión sistemática: análisis de la terapia osteopática en la tendinitis del manguito rotador
dc.title.translated.eng.fl_str_mv Systematic review: analysis of osteopathic therapy in rotator cuff tendinitis
title Revisión sistemática: análisis de la terapia osteopática en la tendinitis del manguito rotador
spellingShingle Revisión sistemática: análisis de la terapia osteopática en la tendinitis del manguito rotador
610 - Medicina y salud
Lesiones del maguito de los rotadores
Rotator Cuff Injuries
Tendinopatía
Tendinopathy
Tendinitis
Manguito rotador
Revision sistematica
Osteopatía
Systematic review
Tendonitis
Rotator cuff
Osteopathy
Manual therapy
Chiropractic
Musculoskeletal
Manipulation
title_short Revisión sistemática: análisis de la terapia osteopática en la tendinitis del manguito rotador
title_full Revisión sistemática: análisis de la terapia osteopática en la tendinitis del manguito rotador
title_fullStr Revisión sistemática: análisis de la terapia osteopática en la tendinitis del manguito rotador
title_full_unstemmed Revisión sistemática: análisis de la terapia osteopática en la tendinitis del manguito rotador
title_sort Revisión sistemática: análisis de la terapia osteopática en la tendinitis del manguito rotador
dc.creator.fl_str_mv Camacho Sanchez, Yely Alexandra
dc.contributor.advisor.none.fl_str_mv Hernandez Arevalo, Abel
Diaz Jimenez, Rafael Edgar
dc.contributor.author.none.fl_str_mv Camacho Sanchez, Yely Alexandra
dc.subject.ddc.spa.fl_str_mv 610 - Medicina y salud
topic 610 - Medicina y salud
Lesiones del maguito de los rotadores
Rotator Cuff Injuries
Tendinopatía
Tendinopathy
Tendinitis
Manguito rotador
Revision sistematica
Osteopatía
Systematic review
Tendonitis
Rotator cuff
Osteopathy
Manual therapy
Chiropractic
Musculoskeletal
Manipulation
dc.subject.decs.SPA.fl_str_mv Lesiones del maguito de los rotadores
dc.subject.decs.ENG.fl_str_mv Rotator Cuff Injuries
dc.subject.lemb.SPA.fl_str_mv Tendinopatía
dc.subject.lemb.ENG.fl_str_mv Tendinopathy
dc.subject.proposal.spa.fl_str_mv Tendinitis
Manguito rotador
Revision sistematica
Osteopatía
dc.subject.proposal.eng.fl_str_mv Systematic review
Tendonitis
Rotator cuff
Osteopathy
Manual therapy
Chiropractic
Musculoskeletal
Manipulation
description ilustraciones, diagrama
publishDate 2023
dc.date.accessioned.none.fl_str_mv 2023-11-27T15:06:09Z
dc.date.available.none.fl_str_mv 2023-11-27T15:06:09Z
dc.date.issued.none.fl_str_mv 2023
dc.type.spa.fl_str_mv Trabajo de grado - Maestría
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/84969
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/84969
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.references.spa.fl_str_mv Allen, h., chan, b. Y., davis, k. W., & blankenbaker, d. G. (2019). Overuse injuries of the shoulder. In radiologic clinics of north america (vol. 57, issue 5, pp. 897–909). W.b. saunders. Https://doi.org/10.1016/j.rcl.2019.03.003
Arcuri, f., barclay, f., & nacul, i. (2014). Translation, cultural adaptation and validation of the simple shoulder test to spanish. Orthopaedic journal of sports medicine, 2(12). Https://doi.org/10.1177/2325967114s00233
Atkinson, M., Mathews, R., Brantingham, J. W., Globe, G., Cassa, T., Bonnefin, D., & Korporaal, C. J. J. o. t. A. C. A. (2008). A randomized controlled trial to assess the efficacy of shoulder manipulation vs. placebo in the treatment of shoulder pain due to rotator cuff tendinopathy. Journal of the American Chiropractic Association
Bakhsh, w., & nicandri, g. (2018). Anatomy and physical examination of the shoulder. Www.sportsmedarthro.com
Brantingham, J. W., Cassa, T. K., Bonnefin, D., Jensen, M., Globe, G., Hicks, M., & Korporaal, C. (2011). Manipulative Therapy for Shoulder Pain and Disorders: Expansion of a Systematic Review. Journal of Manipulative and Physiological Therapeutics, 34(5), 314-346. https://doi.org/10.1016/j.jmpt.2011.04.002
Białoszewski, d., zaborowski, g., rehabilitacji oddziału fizjoterapii wydziału lekarskiego, z. I., uniwersytet medyczny, w., & rehabilitacji, g. (n.d.). Przydatność terapii manualnej w rehabilitacji pacjentów z przewlekłym uszkodzeniem stożka rotatorów stawu ramiennego. Doniesienie wstępne usefulness of manual therapy in the rehabilitation of patients with chronic rotator cuff injuries. Preliminary report.
Clar, c., tsertsvadze, a., court, r., lewando hundt, g., clarke, a., & sutcliffe, p. (2014a). Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of uk evidence report. Http://www.chiromt.com/content/22/1/12
Desjardins charbonneau, a., roy, j. S., dionne, c. E., frémont, p., macdermid, j. C., & desmeules, f. (2015). The efficacy of manual therapy for rotator cuff tendinopathy: a systematic review and meta-analysis. Journal of orthopaedic and sports physical therapy, 45(5), 330–350. Https://doi.org/10.2519/jospt.2015.5455
Ellenbecker, t. S., & cools, a. (2010). Rehabilitation of shoulder impingement syndrome and rotator cuff injuries: an evidence-based review. In british journal of sports medicine (vol. 44, issue 5, pp. 319–327). Https://doi.org/10.1136/bjsm.2009.058875
Bennell, K., Wee, E., Coburn, S., Green, S., Harris, A., Staples, M., . . . Buchbinder, R. (2010). Efficacy of standardised manual therapy and home exercise programme for chronic rotator cuff disease: randomised placebo controlled trial. BMJ, 340, c2756. https://doi.org/10.1136/bmj.c2756
Bennett, S., Macfarlane, C., & Vaughan, B. (2017). The Use of Osteopathic Manual Therapy and Rehabilitation for Subacromial Impingement Syndrome: A Case Report. EXPLORE, 13(5), 339-343. https://doi.org/https://doi.org/10.1016/j.explore.2017.01.002
Çalis, m., akgün, k., birtane, m., karacan, i., çalis, h., tüzün, f., çalis, m., akgün çalis, k. H., & tüzün, f. (2000). Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. In ann rheum dis (vol. 59).
Carreño mesa, f. A., & osma rueda, j. L. (2016a). Diagnóstico de la rotura del manguito de los rotadores (pruebas clínicas e imagenología). Revisión de conceptos actuales. Revista colombiana de ortopedia y traumatología, 30, 13–25. Https://doi.org/10.1016/j.rccot.2016.09.009
Consigliere, p., haddo, o., levy, o., & sforza, g. (2018). Subacromial impingement syndrome: management challenges. In orthopedic research and reviews (vol. 10, pp. 83–91). Dove medical press ltd. Https://doi.org/10.2147/orr.s157864
De kinesiología, a., deporte, d., hospital, r., santojanni, d. F., electromiográfica, r., ejercicios, d. E., & hombro, d. E. (2017). A r g e n t i n a. Www.akd.org.ar|info@akd.org.ar54113221.0798
Fernández Jaén, t. F., Baró pazos, f., Fernández Jiménez, a., & guillén Vicente, m. (2012). Conceptos actuales de la fisiopatología de las tendinopatías. Ingeniería tisular | apunts medicina deportiva. Servicio de medicina y traumatología del deporte, clínica centro, Madrid, España. Https://www.apunts.org/es-conceptos-actuales-fisiopatologia-tendinopatias-ingenieria-articulo-x0213371710873511
Gaut, l., & duprez, d. (2016). Tendon development and diseases. Wiley interdisciplinary reviews: developmental biology, 5(1), 5–23. Https://doi.org/10.1002/wdev.201
Gebremariam, l., hay, e. M., van der sande, r., rinkel, w. D., koes, b. W., & huisstede, b. M. A. (2014). Subacromial impingement syndrome -effectiveness of physiotherapy and manual therapy. In british journal of sports medicine (vol. 48, issue 16, pp. 1202–1208). Bmj publishing group. Https://doi.org/10.1136/bjsports-2012-091802
Hermans, j., luime, j. J., meuffels, d. E., reijman, m., simel, d. L., & bierma-zeinstra, s. M. A. (2013). Does this patient with shoulder pain have rotator cuff disease? The rational clinical examination systematic review. In jama (vol. 310, issue 8, pp. 837–847). American medical association. Https://doi.org/10.1001/jama.2013.276187
Ishigaki, t., yoshino, k., hirokawa, m., sugawara, m., & yamanaka, m. (2022). Supraspinatus tendon thickness and subacromial impingement characteristics in younger and older adults. Bmc musculoskeletal disorders, 23(1). Https://doi.org/10.1186/s12891-022-05179
Jaén, t. F. F., pazos, f. B., jiménez, a. F., vicente, m. G., & garcía, p. G. (2010). Current concepts of the pathophysiology of tendinopathies. Tissue engineering. In apunts medicina de l’esport (vol. 45, issue 168, pp. 259–264). Elsevier doyma. Https://doi.org/10.1016/j.apunts.2010.08.002
Kapandji. (n.d.).
Kirkley, a., alvarez, c., & griffin, s. (2003). The development and evaluation of a disease-specific quality-of-life questionnaire for disorders of the rotator cuff: the western ontario rotator cuff index.
Kolk, a., overbeek, c. L., de witte, p. B., canete, a. N., reijnierse, m., nagels, j., nelissen, r. G. H. H., & de groot, j. H. (2021). Kinematics and muscle activation in subacromial pain syndrome patients and asymptomatic controls. Clinical biomechanics, 89. Https://doi.org/10.1016/j.clinbiomech.2021.105483
Kuhn, j. E. (2009). Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol. Journal of shoulder and elbow surgery, 18(1), 138–160. Https://doi.org/10.1016/j.jse.2008.06.004
Leong, h. T., fu, s. C., he, x., oh, j. H., yamamoto, n., & yung, s. H. P. (2019a). Risk factors for rotator cuff tendinopathy: a systematic review and meta-analysis. In journal of rehabilitation medicine (vol. 51, issue 9, pp. 627–637). Foundation for rehabilitation information. Https://doi.org/10.2340/16501977-2598
Lewis, j., mccreesh, k., roy, j. S., & ginn, k. (2015). Rotator cuff tendinopathy: navigating the diagnosis-management conundrum. In journal of orthopaedic and sports physical therapy (vol. 45, issue 11, pp. 923–937). Movement science media. Https://doi.org/10.2519/jospt.2015.5941
Lorente, t. J. S., ojeda, j., coordinador, d., cabello, i., & heras, g. (n.d.). Capítulo 100-exploración clínica del hombro.
Martínez cano, j. P. , a. G. A. S. , c. S. C. , c. L. A. M. , & m. R. A. (2018). Reliability and internal consistency ofthe spanish version for colombia of thewestern ontario rotator cuff index(worc). Universitas médica, 59(3), 1, 1–6. Https://doi.org/10.11144/javeriana.umed59-3.
Nourissat, g., berenbaum, f., & duprez, d. (2015). Tendon injury: from biology to tendon repair. In nature reviews rheumatology (vol. 11, issue 4, pp. 223–233). Nature publishing group. Https://doi.org/10.1038/nrrheum.2015.26
Pascual.vaca,. (2008). Relación entre las referencias de diagnósticoradiológico de las disfunciones osteopáticasde la cabeza humeral en el plano frontal. Escuela de osteopatía de madrid. Departamento de fisioterapia. Universidad de sevilla
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Ryösä, a., laimi, k., äärimaa, v., lehtimäki, k., kukkonen, j., & saltychev, m. (2017). Surgery or conservative treatment for rotator cuff tear: a meta-analysis. In disability and rehabilitation (vol. 39, issue 14, pp. 1357–1363). Taylor and francis ltd. Https://doi.org/10.1080/09638288.2016.1198431
Sari, a., & eroglu, a. (2020). Comparison of ultrasound-guided platelet-rich plasma, prolotherapy, and corticosteroid injections in rotator cuff lesions. Journal of back and musculoskeletal rehabilitation, 33(3), 387–396. Https://doi.org/10.3233/bmr-191519
Simons, s. M. M. F., dixon, bryan. M., kruse, d. M., campos, k. B. M., & grayzel, jonathan. M. F. (2022). Presentación y diagnóstico de los desgarros del manguito rotador autores. Www.uptodate.com
Smith, d. L., & campbell, s. M. (n.d.). Clinical reviews painful shoulder syndromes: diagnosis and management.
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Tate, a. R., mcclure, p. W., young, i. A., salvatori, r., & michener, l. A. (2010). Comprehensive impairment-based exercise and manual therapy intervention for patients with subacromial impingement syndrome: a case series. Journal of orthopaedic and sports physical therapy, 40(8), 474–493. Https://doi.org/10.2519/jospt.2010.3223
Varacallo, m., & el bitar, y. (2022). Síndrome del manguito rotador. Stat pearls
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dc.format.extent.spa.fl_str_mv 129páginas
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dc.publisher.spa.fl_str_mv Universidad Nacional de Colombia
dc.publisher.program.spa.fl_str_mv Bogotá - Medicina - Maestría en Medicina Alternativa
dc.publisher.faculty.spa.fl_str_mv Facultad de Medicina
dc.publisher.place.spa.fl_str_mv Bogotá, Colombia
Bogotá, Colombia
dc.publisher.branch.spa.fl_str_mv Universidad Nacional de Colombia - Sede Bogotá
institution Universidad Nacional de Colombia
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spelling Atribución-NoComercial 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Hernandez Arevalo, Abel2428486678530775cdf2bc4e38e54468Diaz Jimenez, Rafael Edgar6ad78343fdc3e0e03c083a4033360637Camacho Sanchez, Yely Alexandra5637fc08ad7e27f8a8d9194b0714b8ac2023-11-27T15:06:09Z2023-11-27T15:06:09Z2023https://repositorio.unal.edu.co/handle/unal/84969Universidad Nacional de ColombiaRepositorio Institucional Universidad Nacional de Colombiahttps://repositorio.unal.edu.co/ilustraciones, diagramaLa presente revisión sistemática de la literatura se enfoca en el análisis de la eficacia de la terapia osteopática en el tratamiento de la tendinitis del manguito rotador. Se llevó a cabo una búsqueda exhaustiva de estudios en bases de datos reconocidas, como Pubmed, Cochrane Library, Lilacs y el International Journal of Osteopathic Medicine, lo que condujo a la identificación de 10 estudios que cumplían con los criterios de inclusión establecidos. Para evaluar el riesgo de sesgo en los estudios seleccionados, se utilizaron diversas herramientas como, Cochrane Risk of Bias (ROB), Risk of Bias Assessment Tool (ROBIS) y las herramientas JBI (Joanna Briggs Institute). La calidad de la evidencia obtenida se evaluó mediante la herramienta GRADE Pro y los resultados se presentan a través de una síntesis narrativa. Los hallazgos de esta revisión revelaron evidencia de calidad que varía entre baja y moderada. Los resultados sugieren que la osteopatía puede contribuir a la disminución del dolor y a la mejoría del rango de movilidad en pacientes que padecen tendinitis del manguito rotador. Estos efectos se observaron comparándolos con diversos tratamientos convencionales disponibles para esta afección. La revisión da indicios alentadores sobre la utilidad de la osteopatía en el manejo de la tendinitis del manguito rotador, aunque se subraya la necesidad de continuar investigando para conocer sus efectos y ventajas potenciales. Palabras claves: manguito rotador, osteopatía, terapia manual, quiropraxia, manipulación musculoesquelética. (Texto tomado de la fuenyte)The present systematic review of the literature focuses on the analysis of the efficacy of osteopathic therapy in the treatment of rotator cuff tendinitis. A comprehensive search for studies was conducted in recognised databases, such as Pubmed, Cochrane Library, Lilacs and the International Journal of Osteopathic Medicine, which led to the identification of 10 studies that met the established inclusion criteria. To assess the risk of bias in the selected studies, we used various tools such as Cochrane Risk of Bias (ROB), Risk of Bias Assessment Tool (ROBIS) and JBI tools (Joanna Briggs Institute). The quality of the evidence obtained was assessed using the GRADE Pro tool and the results are presented through a narrative synthesis. The findings of this review revealed quality evidence ranging from low to moderate. The results suggest that osteopathy may contribute to decreased pain and improved range of motion in patients suffering from rotator cuff tendinitis. These effects were seen in comparison with various conventional treatments available for this condition. However, the review gives encouraging indications about the usefulness of osteopathy in the management of rotator cuff tendonitis, although it underlines the need for further research to know its effects and potential advantages.MaestríaMagíster en Medicina Alternativarevisión sistemática: Cochrane Risk of Bias (ROB), Risk of Bias Assessment Tool (ROBIS) y las herramientas JBI (Joanna Briggs Institute). GRADE pro129páginasapplication/pdfspaUniversidad Nacional de ColombiaBogotá - Medicina - Maestría en Medicina AlternativaFacultad de MedicinaBogotá, ColombiaBogotá, ColombiaUniversidad Nacional de Colombia - Sede Bogotá610 - Medicina y saludLesiones del maguito de los rotadoresRotator Cuff InjuriesTendinopatíaTendinopathyTendinitisManguito rotadorRevision sistematicaOsteopatíaSystematic reviewTendonitisRotator cuffOsteopathyManual therapyChiropracticMusculoskeletalManipulationRevisión sistemática: análisis de la terapia osteopática en la tendinitis del manguito rotadorSystematic review: analysis of osteopathic therapy in rotator cuff tendinitisTrabajo de grado - Maestríainfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/acceptedVersionTexthttp://purl.org/redcol/resource_type/TMAllen, h., chan, b. Y., davis, k. W., & blankenbaker, d. G. (2019). Overuse injuries of the shoulder. In radiologic clinics of north america (vol. 57, issue 5, pp. 897–909). W.b. saunders. Https://doi.org/10.1016/j.rcl.2019.03.003Arcuri, f., barclay, f., & nacul, i. (2014). Translation, cultural adaptation and validation of the simple shoulder test to spanish. Orthopaedic journal of sports medicine, 2(12). Https://doi.org/10.1177/2325967114s00233Atkinson, M., Mathews, R., Brantingham, J. W., Globe, G., Cassa, T., Bonnefin, D., & Korporaal, C. J. J. o. t. A. C. A. (2008). A randomized controlled trial to assess the efficacy of shoulder manipulation vs. placebo in the treatment of shoulder pain due to rotator cuff tendinopathy. Journal of the American Chiropractic AssociationBakhsh, w., & nicandri, g. (2018). Anatomy and physical examination of the shoulder. Www.sportsmedarthro.comBrantingham, J. W., Cassa, T. K., Bonnefin, D., Jensen, M., Globe, G., Hicks, M., & Korporaal, C. (2011). Manipulative Therapy for Shoulder Pain and Disorders: Expansion of a Systematic Review. Journal of Manipulative and Physiological Therapeutics, 34(5), 314-346. https://doi.org/10.1016/j.jmpt.2011.04.002Białoszewski, d., zaborowski, g., rehabilitacji oddziału fizjoterapii wydziału lekarskiego, z. I., uniwersytet medyczny, w., & rehabilitacji, g. (n.d.). Przydatność terapii manualnej w rehabilitacji pacjentów z przewlekłym uszkodzeniem stożka rotatorów stawu ramiennego. Doniesienie wstępne usefulness of manual therapy in the rehabilitation of patients with chronic rotator cuff injuries. Preliminary report.Clar, c., tsertsvadze, a., court, r., lewando hundt, g., clarke, a., & sutcliffe, p. (2014a). Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of uk evidence report. Http://www.chiromt.com/content/22/1/12Desjardins charbonneau, a., roy, j. S., dionne, c. E., frémont, p., macdermid, j. C., & desmeules, f. (2015). The efficacy of manual therapy for rotator cuff tendinopathy: a systematic review and meta-analysis. Journal of orthopaedic and sports physical therapy, 45(5), 330–350. Https://doi.org/10.2519/jospt.2015.5455Ellenbecker, t. S., & cools, a. (2010). Rehabilitation of shoulder impingement syndrome and rotator cuff injuries: an evidence-based review. In british journal of sports medicine (vol. 44, issue 5, pp. 319–327). Https://doi.org/10.1136/bjsm.2009.058875Bennell, K., Wee, E., Coburn, S., Green, S., Harris, A., Staples, M., . . . Buchbinder, R. (2010). Efficacy of standardised manual therapy and home exercise programme for chronic rotator cuff disease: randomised placebo controlled trial. BMJ, 340, c2756. https://doi.org/10.1136/bmj.c2756Bennett, S., Macfarlane, C., & Vaughan, B. (2017). The Use of Osteopathic Manual Therapy and Rehabilitation for Subacromial Impingement Syndrome: A Case Report. 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Https://doi.org/10.1016/j.recot.2016.07.003EstudiantesInvestigadoresMaestrosPersonal de apoyo escolarPúblico generalLICENSElicense.txtlicense.txttext/plain; charset=utf-85879https://repositorio.unal.edu.co/bitstream/unal/84969/3/license.txteb34b1cf90b7e1103fc9dfd26be24b4aMD53ORIGINAL1022330408.2023.pdf1022330408.2023.pdfTesis de Maestría en Medicina Alternativaapplication/pdf2231799https://repositorio.unal.edu.co/bitstream/unal/84969/4/1022330408.2023.pdffcb36c439a590500bcf93aa5d160b8b7MD54THUMBNAIL1022330408.2023.pdf.jpg1022330408.2023.pdf.jpgGenerated Thumbnailimage/jpeg3896https://repositorio.unal.edu.co/bitstream/unal/84969/5/1022330408.2023.pdf.jpgf0ec0c676c1e35273279c01706562c05MD55unal/84969oai:repositorio.unal.edu.co:unal/849692023-11-27 23:03:38.042Repositorio Institucional Universidad Nacional de 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