Efecto del ejercicio terapéutico en la variabilidad de la frecuencia cardíaca de pacientes con enfermedad coronaria
ilustraciones, gráficas
- Autores:
-
Cárdenas Granados, Rubén Darío
- 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/81093
- Palabra clave:
- 610 - Medicina y salud::616 - Enfermedades
Terapia por Ejercicio
Frecuencia Cardíaca
Exercise Therapy
Heart rate
Coronary heart disease
Enfermedad coronaria
Variabilidad de la frecuencia cardíaca
Enfermedad coronaria
Ejercicio
Inferencia bayesiana
Rehabilitación cardíaca
Heart rate variability
Coronary artery disease
Exercise
Bayesian inference
Cardiac rehabilitation
- Rights
- openAccess
- License
- Atribución-NoComercial 4.0 Internacional
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Efecto del ejercicio terapéutico en la variabilidad de la frecuencia cardíaca de pacientes con enfermedad coronaria |
| dc.title.translated.eng.fl_str_mv |
Effect of therapeutic exercise on heart rate variability in patients with coronary artery disease |
| title |
Efecto del ejercicio terapéutico en la variabilidad de la frecuencia cardíaca de pacientes con enfermedad coronaria |
| spellingShingle |
Efecto del ejercicio terapéutico en la variabilidad de la frecuencia cardíaca de pacientes con enfermedad coronaria 610 - Medicina y salud::616 - Enfermedades Terapia por Ejercicio Frecuencia Cardíaca Exercise Therapy Heart rate Coronary heart disease Enfermedad coronaria Variabilidad de la frecuencia cardíaca Enfermedad coronaria Ejercicio Inferencia bayesiana Rehabilitación cardíaca Heart rate variability Coronary artery disease Exercise Bayesian inference Cardiac rehabilitation |
| title_short |
Efecto del ejercicio terapéutico en la variabilidad de la frecuencia cardíaca de pacientes con enfermedad coronaria |
| title_full |
Efecto del ejercicio terapéutico en la variabilidad de la frecuencia cardíaca de pacientes con enfermedad coronaria |
| title_fullStr |
Efecto del ejercicio terapéutico en la variabilidad de la frecuencia cardíaca de pacientes con enfermedad coronaria |
| title_full_unstemmed |
Efecto del ejercicio terapéutico en la variabilidad de la frecuencia cardíaca de pacientes con enfermedad coronaria |
| title_sort |
Efecto del ejercicio terapéutico en la variabilidad de la frecuencia cardíaca de pacientes con enfermedad coronaria |
| dc.creator.fl_str_mv |
Cárdenas Granados, Rubén Darío |
| dc.contributor.advisor.spa.fl_str_mv |
Chaustre Ruíz, Diego Mauricio Mendoza Pulido, Juan Camilo |
| dc.contributor.author.spa.fl_str_mv |
Cárdenas Granados, Rubén Darío |
| dc.contributor.datacollector.spa.fl_str_mv |
Grupo de rehabilitación HOCEN |
| dc.contributor.hostingInstitution.spa.fl_str_mv |
Hospital Central de la Policía Nacional |
| dc.subject.ddc.spa.fl_str_mv |
610 - Medicina y salud::616 - Enfermedades |
| topic |
610 - Medicina y salud::616 - Enfermedades Terapia por Ejercicio Frecuencia Cardíaca Exercise Therapy Heart rate Coronary heart disease Enfermedad coronaria Variabilidad de la frecuencia cardíaca Enfermedad coronaria Ejercicio Inferencia bayesiana Rehabilitación cardíaca Heart rate variability Coronary artery disease Exercise Bayesian inference Cardiac rehabilitation |
| dc.subject.decs.spa.fl_str_mv |
Terapia por Ejercicio Frecuencia Cardíaca |
| dc.subject.decs.eng.fl_str_mv |
Exercise Therapy Heart rate |
| dc.subject.lemb.eng.fl_str_mv |
Coronary heart disease |
| dc.subject.lemb.spa.fl_str_mv |
Enfermedad coronaria |
| dc.subject.proposal.spa.fl_str_mv |
Variabilidad de la frecuencia cardíaca Enfermedad coronaria Ejercicio Inferencia bayesiana Rehabilitación cardíaca |
| dc.subject.proposal.eng.fl_str_mv |
Heart rate variability Coronary artery disease Exercise Bayesian inference Cardiac rehabilitation |
| description |
ilustraciones, gráficas |
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2022 |
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2022-03-01T16:18:56Z |
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2022-03-01T16:18:56Z |
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2022-02 |
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Trabajo de grado - Especialidad Médica |
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info:eu-repo/semantics/masterThesis |
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Universidad Nacional de Colombia |
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spa |
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Perkiömäki J, Mäkikallio T, Huikuri H. Fractal and complexity measures of heart rate variability. Clin Exp Hypertens. 2005;27(2 3):149-58 Huikuri HV, Mäkikallio TH, Perkiömäki J. Measurement of heart rate variability by methods based on nonlinear dynamics. J Electrocardiol. 2003;36:95-9 Mäkikallio TH, Tapanainen JM, Tulppo MP, Huikuri HV. Clinical applicability of heart rate variability analysis by methods based on nonlinear dynamics. Card Electrophysiol Rev. 2002;6(3):250-5 Krstacic G, Krstacic A, Smalcelj A, Milicic D, Jembrek-Gostovic M. The «Chaos Theory» and nonlinear dynamics in heart rate variability analysis: does it work in short-time series in patients with coronary heart disease? Ann Noninvasive Electrocardiol. 2007;12(2):130-6 Steeds R, Fletcher J, Smith M, West J, Channer K, Townend J. Prognostic significance of early short-term measurements of heart rate variability following acute myocardial infarction. Am J Cardiol. 2004;94:1275-8 Routledge F, Campbell T, McFetridge-Durdle J, Bacon S. Improvements in heart rate variability with exercise therapy. Can J Cardiol. 2010;26(6):303-3012 Sociedad Interamericana de Cardiología, Sociedad Sudamericana de Cardiología, Comité Interamericano de Prevención y Rehabilitación Cardiovascular. Consenso de Rehabilitación Cardiovascular y Prevención Secundaria de las Sociedades Interamericana y Sudamericana de Cardiología. Rev Urug Cardiol. 2013;28:189- 224 Vélez C, Gil L, Avila C, López A. Factores de riesgo cardiovascular y variables asociadas en personas de 20 a 79 años en Manizales, Colombia. Rev Univ salud. 2015;17(1):32-46 Pencina M, Navar A, Wojdyla D, Sanchez R, Khan I, Elassal J, et al. Quantifying Importance of Major Risk Factors for Coronary Heart Disease. Circulation. 2019;139:1603-11 ACC/AHA. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(2):S49-73 European Society of Cardiology. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal. 2016;37:2315-81 American Association of Cardiovascular & Pulmonary Rehabilitation. Guidelines for cardiac rehabilitation and secondary prevention programs / American Association of Cardiovascular and Pulmonary Rehabilitation. 5th ed. Human Kinetics; 2013 Devrome AN, Aggarwal S, McMurtry MS, Southern D, Hauer T, Lamb B, et al. Cardiac rehabilitation in people with peripheral arterial disease: A higher risk population that benefits from completion. Int J Cardiol. 2019;S0167-5273(19)30305- 5 Morris JH, Chen L. Exercise Training and Heart Failure: A Review of the Literature. Card Fail Rev. 2019;5(1):57-61 Marzolini S, Oh P, Brooks D. Effect of combined aerobic and resistance training versus aerobic training alone in individuals with coronary artery disease: a metaanalysis. European Journal of Preventive Cardiology. 2011;19(1):81-94 Task Force of The European Society of Cardiology and The North American Society of Pacing and Electrophysiology. Heart rate variability Standards of measurement, physiological interpretation, and clinical use. Eur Heart J. 1996;17:354-81 Karavaev A., Ishbulatov Yu., Ponomarenko V., Bezruchko B., Kiselev R., Prokhorov M. Autonomic control is a source of dynamical chaos in the cardiovascular system. Chaos. 2019;29:121101 Shaffer F., Ginsberg P. An Overview of Heart Rate variability Metrics and Norms. Front Public Health. 2017;5:258. doi: 10.3389/fpubh.2017.00258 Kiviniemi AM., Tulppo MP, Wichterle D., Hautala A., Tiinanen S., Seppänen T, et al. Novel spectral indexes of heart rate variability as predictors of sudden and nonsudden cardiac death after an acute myocardial infarction. Ann Med. 2007;39(1):54- 62 Milicevic G., Fort L., Majsec M., Bakula V. Heart rate variability decreased by coronary artery surgery has no prognostic value. Eur J Cardiovasc Prev Rehabil. 2004;11:228-32 Martins R., Rehder P., Polaquini R., Catai A. Can high-intensity interval training change cardiac autonomic control? A systematic review. Braz J Phys Ther. 2019;23(4):279-89 Sandercock GR., Grocott-Mason R., Brodie DA. Changes in short-term measures of heart rate variability after eight weeks of cardiac rehabilitation. Clin Auton Res. 2007;17:39-45 Manresa A, Ribeiro F., Sarabia J., Íbias J., Oliveira N., Vera J., et al. Exercisebased cardiac rehabilitation and parasympathetic function in patients with coronary artery disease: a systematic review and meta-analysis. Clin Auton Res. 2020;doi: 10.1007/s10286-020-00687-0. Online ahead of print Gomes T., Muniz H., Ribeiro V., Vasconcelos A., Dornelas A., Cunha D. Effects of physical exercise on the autonomic nervous system in patients with coronary artery disease: A systematic review. Expert Rev Cardiovasc Ther. 2020;doi: 10.1080/14779072.2020.1813568. Online ahead of print Yentes J, Hunt N, Schmid K, Kaipust J, Stergiou N. The Appropriate Use of Approximate Entropy and Sample Entropy with Short Data Sets. Ann Biomed Eng. 2013;41(2):349-65 Richman J, Moorman J. Physiological time-series analysis using approximate entropy and sample entropy. Am J Physiol Heart Circ Physiol. 2000;278(6):H2039- 49 American Association of Cardiovascular & Pulmonary Rehabilitation. Guidelines for cardiac rehabilitation and secondary prevention programs / American Association of Cardiovascular and Pulmonary Rehabilitation. 5th ed. Human Kinetics; 2013 ACSM. Guidelines for Exercise Testing and Prescription. 11.a ed. Millholen A, Ries L, editores. Philadelphia: Wolters Kluwer; 2022 Tarvainen MP, Niskanen JP, Lipponen JA, Ranta-Aho PO, Karjalainen PA. Kubios HRV--heart rate variability analysis software. Comput Methods Programs Biomed. 2014;113(1):210-20. doi: 10.1016/j.cmpb.2013.07.024. Epub 2013 Aug 6 van Doorn J, van den Bergh D, Böhm U, Dablander F, Derks K, Draws T, et al. The JASP guidelines for conducting and reporting a Bayesian analysis. Psychon Bull Rev. 2021;28:813-26 Goss-Sampson M. JASP – Bayesian Inference [Internet]. van Doorn J, Wagenmakers EJ, editores. 2020. Disponible en: http://static.jaspstats.org/Manuals/Bayesian_Guide_v0.12.2.pdf |
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Universidad Nacional de Colombia |
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Bogotá - Medicina - Especialidad en Medicina Física y Rehabilitación |
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Departamento de Medicina Física y Rehabilitacion |
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Facultad de Medicina |
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Bogotá, Colombia |
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Universidad Nacional de Colombia - Sede Bogotá |
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Atribución-NoComercial 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Chaustre Ruíz, Diego Mauriciocd91fb451ae45c2ee65cf8e6df28e533600Mendoza Pulido, Juan Camilo05468ef5aa72883133a909cb7aaf1e66Cárdenas Granados, Rubén Darío65fbe66d8180b36a87bbe20db3965c5c600Grupo de rehabilitación HOCENHospital Central de la Policía Nacional2022-03-01T16:18:56Z2022-03-01T16:18:56Z2022-02https://repositorio.unal.edu.co/handle/unal/81093Universidad Nacional de ColombiaRepositorio Institucional Universidad Nacional de Colombiahttps://repositorio.unal.edu.co/ilustraciones, gráficasObjetivo. Evaluar el efecto del ejercicio terapéutico utilizado en un programa de rehabilitación cardíaca en la variabilidad de la frecuencia cardíaca (HRV) a corto plazo de pacientes con enfermedad coronaria (EC). Materiales y métodos. Estudio observacional analítico. 24 pacientes fueron incluidos y 10 completaron datos de egreso (60,1 ± 7,1 años). Los intervalos RR se registraron en reposo con un monitor Polar H7 durante un periodo de 15 minutos. Los índices de la HRV a corto plazo en dominio del tiempo (DT), de la frecuencia (DF), no lineales (NL) e índices autonómicos se calcularon en el software Kubios HRV. Se realizó inferencia bayesiana para verificar el efecto del ejercicio terapéutico y la correlación entre los índices de la HRV. Resultados. El análisis inicial, al ingreso del programa de rehabilitación, evidenció disminución de la HRV asociada a un balance simpático - vagal positivo, con incremento de la actividad simpática. No se observó diferencia de la HRV en función del sexo, infarto de miocardio ni tabaquismo. El análisis posterior, al finalizar el programa de rehabilitación, mostró incremento de la actividad parasimpática, disminución de la simpática y recuperación de la complejidad de la HRV. Conclusiones. El ejercicio mejora la HRV y el balance simpático vagal, disminuyendo la actividad simpática e incrementando la parasimpática, en pacientes con EC. Los índices NL y los autonómicos son medidas útiles para evaluar el impacto de la rehabilitación cardíaca en pacientes con EC. (Texto tomado de la fuente).Objective. To evaluate the effect of therapeutic exercise used in a cardiac rehabilitation program on short-term heart rate variability (HRV) in patients with coronary heart disease (CHD). Materials and methods. Analytical observational study. Twenty-four patients were included and 10 completed discharge data (60.1 ± 7.1 years). RR intervals were recorded at rest with a Polar H7 monitor during a 15-minute period. Time-domain (TD), frequency domain (FD), nonlinear (NL) and autonomic HRV indices were calculated in Kubios HRV software. Bayesian inference was performed to verify the effect of therapeutic exercise and the correlation between HRV indices. Results. The initial analysis, at the beginning of the rehabilitation program, showed a decrease in HRV associated with a positive sympathetic vagal balance, with an increase in sympathetic activity. No differences were observed in HRV according to sex, myocardial infarction or smoking. Subsequent analysis, at the end of the rehabilitation program, showed an increase in parasympathetic activity, a decrease in sympathetic activity and recovery of HRV complexity. Conclusions. Exercise improves HRV and vagal sympathetic balance, decreasing sympathetic activity and increasing parasympathetic activity, in patients with CD. NL and autonomic indices are useful measures to assess the impact of cardiac rehabilitation in patients with CD.Incluye anexosEspecialidades MédicasEspecialista en Medicina Física y RehabilitaciónEstudio observacional de tipo analítico de la Variabilidad de la Frecuencia Cardíaca (HRV) en pacientes con enfermedad coronaria (EC) que realizaron un programa de rehabilitación cardíaca en la ciudad de Bogotá. En este estudio se realizó un muestreo por conveniencia y los índices autonómicos, en el dominio del tiempo (DT), en el dominio de la frecuencia (DF) y los parámetros no lineales (NL) de la HRV fueron medidos al inicio y al final de la fase 2 de dicho programa de rehabilitación. Posteriormente, el efecto del ejercicio terapéutico en la HRV a corto plazo fue verificado a través de pruebas de hipótesis con factor de Bayes (BF)Rehabilitación cardiopulmonarxix, 103 páginasapplication/pdfspaUniversidad Nacional de ColombiaBogotá - Medicina - Especialidad en Medicina Física y RehabilitaciónDepartamento de Medicina Física y RehabilitacionFacultad de MedicinaBogotá, ColombiaUniversidad Nacional de Colombia - Sede Bogotá610 - Medicina y salud::616 - EnfermedadesTerapia por EjercicioFrecuencia CardíacaExercise TherapyHeart rateCoronary heart diseaseEnfermedad coronariaVariabilidad de la frecuencia cardíacaEnfermedad coronariaEjercicioInferencia bayesianaRehabilitación cardíacaHeart rate variabilityCoronary artery diseaseExerciseBayesian inferenceCardiac rehabilitationEfecto del ejercicio terapéutico en la variabilidad de la frecuencia cardíaca de pacientes con enfermedad coronariaEffect of therapeutic exercise on heart rate variability in patients with coronary artery diseaseTrabajo de grado - Especialidad Médicainfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/acceptedVersionTexthttp://purl.org/redcol/resource_type/TMBiremePerkiömäki J, Mäkikallio T, Huikuri H. Fractal and complexity measures of heart rate variability. Clin Exp Hypertens. 2005;27(2 3):149-58Huikuri HV, Mäkikallio TH, Perkiömäki J. Measurement of heart rate variability by methods based on nonlinear dynamics. J Electrocardiol. 2003;36:95-9Mäkikallio TH, Tapanainen JM, Tulppo MP, Huikuri HV. Clinical applicability of heart rate variability analysis by methods based on nonlinear dynamics. Card Electrophysiol Rev. 2002;6(3):250-5Krstacic G, Krstacic A, Smalcelj A, Milicic D, Jembrek-Gostovic M. The «Chaos Theory» and nonlinear dynamics in heart rate variability analysis: does it work in short-time series in patients with coronary heart disease? Ann Noninvasive Electrocardiol. 2007;12(2):130-6Steeds R, Fletcher J, Smith M, West J, Channer K, Townend J. Prognostic significance of early short-term measurements of heart rate variability following acute myocardial infarction. Am J Cardiol. 2004;94:1275-8Routledge F, Campbell T, McFetridge-Durdle J, Bacon S. Improvements in heart rate variability with exercise therapy. Can J Cardiol. 2010;26(6):303-3012Sociedad Interamericana de Cardiología, Sociedad Sudamericana de Cardiología, Comité Interamericano de Prevención y Rehabilitación Cardiovascular. Consenso de Rehabilitación Cardiovascular y Prevención Secundaria de las Sociedades Interamericana y Sudamericana de Cardiología. Rev Urug Cardiol. 2013;28:189- 224Vélez C, Gil L, Avila C, López A. Factores de riesgo cardiovascular y variables asociadas en personas de 20 a 79 años en Manizales, Colombia. Rev Univ salud. 2015;17(1):32-46Pencina M, Navar A, Wojdyla D, Sanchez R, Khan I, Elassal J, et al. Quantifying Importance of Major Risk Factors for Coronary Heart Disease. Circulation. 2019;139:1603-11ACC/AHA. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(2):S49-73European Society of Cardiology. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal. 2016;37:2315-81American Association of Cardiovascular & Pulmonary Rehabilitation. Guidelines for cardiac rehabilitation and secondary prevention programs / American Association of Cardiovascular and Pulmonary Rehabilitation. 5th ed. Human Kinetics; 2013Devrome AN, Aggarwal S, McMurtry MS, Southern D, Hauer T, Lamb B, et al. Cardiac rehabilitation in people with peripheral arterial disease: A higher risk population that benefits from completion. Int J Cardiol. 2019;S0167-5273(19)30305- 5Morris JH, Chen L. Exercise Training and Heart Failure: A Review of the Literature. Card Fail Rev. 2019;5(1):57-61Marzolini S, Oh P, Brooks D. Effect of combined aerobic and resistance training versus aerobic training alone in individuals with coronary artery disease: a metaanalysis. European Journal of Preventive Cardiology. 2011;19(1):81-94Task Force of The European Society of Cardiology and The North American Society of Pacing and Electrophysiology. Heart rate variability Standards of measurement, physiological interpretation, and clinical use. Eur Heart J. 1996;17:354-81Karavaev A., Ishbulatov Yu., Ponomarenko V., Bezruchko B., Kiselev R., Prokhorov M. Autonomic control is a source of dynamical chaos in the cardiovascular system. Chaos. 2019;29:121101Shaffer F., Ginsberg P. An Overview of Heart Rate variability Metrics and Norms. Front Public Health. 2017;5:258. doi: 10.3389/fpubh.2017.00258Kiviniemi AM., Tulppo MP, Wichterle D., Hautala A., Tiinanen S., Seppänen T, et al. Novel spectral indexes of heart rate variability as predictors of sudden and nonsudden cardiac death after an acute myocardial infarction. Ann Med. 2007;39(1):54- 62Milicevic G., Fort L., Majsec M., Bakula V. Heart rate variability decreased by coronary artery surgery has no prognostic value. Eur J Cardiovasc Prev Rehabil. 2004;11:228-32Martins R., Rehder P., Polaquini R., Catai A. Can high-intensity interval training change cardiac autonomic control? A systematic review. Braz J Phys Ther. 2019;23(4):279-89Sandercock GR., Grocott-Mason R., Brodie DA. Changes in short-term measures of heart rate variability after eight weeks of cardiac rehabilitation. Clin Auton Res. 2007;17:39-45Manresa A, Ribeiro F., Sarabia J., Íbias J., Oliveira N., Vera J., et al. Exercisebased cardiac rehabilitation and parasympathetic function in patients with coronary artery disease: a systematic review and meta-analysis. Clin Auton Res. 2020;doi: 10.1007/s10286-020-00687-0. Online ahead of printGomes T., Muniz H., Ribeiro V., Vasconcelos A., Dornelas A., Cunha D. Effects of physical exercise on the autonomic nervous system in patients with coronary artery disease: A systematic review. Expert Rev Cardiovasc Ther. 2020;doi: 10.1080/14779072.2020.1813568. Online ahead of printYentes J, Hunt N, Schmid K, Kaipust J, Stergiou N. The Appropriate Use of Approximate Entropy and Sample Entropy with Short Data Sets. Ann Biomed Eng. 2013;41(2):349-65Richman J, Moorman J. Physiological time-series analysis using approximate entropy and sample entropy. Am J Physiol Heart Circ Physiol. 2000;278(6):H2039- 49American Association of Cardiovascular & Pulmonary Rehabilitation. Guidelines for cardiac rehabilitation and secondary prevention programs / American Association of Cardiovascular and Pulmonary Rehabilitation. 5th ed. Human Kinetics; 2013ACSM. Guidelines for Exercise Testing and Prescription. 11.a ed. Millholen A, Ries L, editores. Philadelphia: Wolters Kluwer; 2022Tarvainen MP, Niskanen JP, Lipponen JA, Ranta-Aho PO, Karjalainen PA. Kubios HRV--heart rate variability analysis software. Comput Methods Programs Biomed. 2014;113(1):210-20. doi: 10.1016/j.cmpb.2013.07.024. Epub 2013 Aug 6van Doorn J, van den Bergh D, Böhm U, Dablander F, Derks K, Draws T, et al. The JASP guidelines for conducting and reporting a Bayesian analysis. Psychon Bull Rev. 2021;28:813-26Goss-Sampson M. JASP – Bayesian Inference [Internet]. van Doorn J, Wagenmakers EJ, editores. 2020. Disponible en: http://static.jaspstats.org/Manuals/Bayesian_Guide_v0.12.2.pdfEstudiantesInvestigadoresORIGINAL1090390816.2022.pdf1090390816.2022.pdfTesis de Especialidad en Medicina Física y Rehabilitaciónapplication/pdf2004859https://repositorio.unal.edu.co/bitstream/unal/81093/4/1090390816.2022.pdf88d26bf5d56ddf85e76db24e7fe24282MD54LICENSElicense.txtlicense.txttext/plain; charset=utf-84074https://repositorio.unal.edu.co/bitstream/unal/81093/5/license.txt8153f7789df02f0a4c9e079953658ab2MD55THUMBNAIL1090390816.2022.pdf.jpg1090390816.2022.pdf.jpgGenerated Thumbnailimage/jpeg4961https://repositorio.unal.edu.co/bitstream/unal/81093/6/1090390816.2022.pdf.jpgc281e027bcf70906f6b470b02a609497MD56unal/81093oai:repositorio.unal.edu.co:unal/810932024-08-03 23:10:37.306Repositorio Institucional Universidad Nacional de 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