Asociación entre la ferropenia y las escalas funcionales New york Heart Association (NYHA) y la fracción de eyección del ventrículo izquierdo (FEVI) en los pacientes con diagnostico con insuficiencia cardiaca descompensada

Objective: To characterize iron deficiency patients diagnosed with heart failure and to analyze probable associations between the New York Heart Association (NYHA) scales and the left ventricular ejection fraction (LVEF) in a third level hospital in Bogotá Dc. Methods: A descriptive cross-sectional...

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Calderon Franco, Carlos Hernan
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https://purl.org/coar/resource_type/c_7a1f
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2024
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Universidad El Bosque
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Repositorio U. El Bosque
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oai:repositorio.unbosque.edu.co:20.500.12495/13939
Acceso en línea:
https://hdl.handle.net/20.500.12495/13939
Palabra clave:
Insuficiencia cardiaca, Ferropenia, New York Heart Association, Anemia.
Keywords: Heart failure, iron deficiency, New York Heart Association, Anemia.
WB 115
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dc.title.none.fl_str_mv Asociación entre la ferropenia y las escalas funcionales New york Heart Association (NYHA) y la fracción de eyección del ventrículo izquierdo (FEVI) en los pacientes con diagnostico con insuficiencia cardiaca descompensada
dc.title.translated.none.fl_str_mv Association between iron deficiency and the New York Heart Association (NYHA) functional scales and left ventricular ejection fraction (LVEF) in patients diagnosed with decompensated heart failure
title Asociación entre la ferropenia y las escalas funcionales New york Heart Association (NYHA) y la fracción de eyección del ventrículo izquierdo (FEVI) en los pacientes con diagnostico con insuficiencia cardiaca descompensada
spellingShingle Asociación entre la ferropenia y las escalas funcionales New york Heart Association (NYHA) y la fracción de eyección del ventrículo izquierdo (FEVI) en los pacientes con diagnostico con insuficiencia cardiaca descompensada
Insuficiencia cardiaca, Ferropenia, New York Heart Association, Anemia.
Keywords: Heart failure, iron deficiency, New York Heart Association, Anemia.
WB 115
title_short Asociación entre la ferropenia y las escalas funcionales New york Heart Association (NYHA) y la fracción de eyección del ventrículo izquierdo (FEVI) en los pacientes con diagnostico con insuficiencia cardiaca descompensada
title_full Asociación entre la ferropenia y las escalas funcionales New york Heart Association (NYHA) y la fracción de eyección del ventrículo izquierdo (FEVI) en los pacientes con diagnostico con insuficiencia cardiaca descompensada
title_fullStr Asociación entre la ferropenia y las escalas funcionales New york Heart Association (NYHA) y la fracción de eyección del ventrículo izquierdo (FEVI) en los pacientes con diagnostico con insuficiencia cardiaca descompensada
title_full_unstemmed Asociación entre la ferropenia y las escalas funcionales New york Heart Association (NYHA) y la fracción de eyección del ventrículo izquierdo (FEVI) en los pacientes con diagnostico con insuficiencia cardiaca descompensada
title_sort Asociación entre la ferropenia y las escalas funcionales New york Heart Association (NYHA) y la fracción de eyección del ventrículo izquierdo (FEVI) en los pacientes con diagnostico con insuficiencia cardiaca descompensada
dc.creator.fl_str_mv Calderon Franco, Carlos Hernan
dc.contributor.advisor.none.fl_str_mv Toledo Arenas, Jose Daniel
Baquero Lozano, Gary Andres
dc.contributor.author.none.fl_str_mv Calderon Franco, Carlos Hernan
dc.contributor.orcid.none.fl_str_mv Calderon franco, Carlos Hernán [0000-0002-9823-8409]
dc.subject.none.fl_str_mv Insuficiencia cardiaca, Ferropenia, New York Heart Association, Anemia.
topic Insuficiencia cardiaca, Ferropenia, New York Heart Association, Anemia.
Keywords: Heart failure, iron deficiency, New York Heart Association, Anemia.
WB 115
dc.subject.keywords.none.fl_str_mv Keywords: Heart failure, iron deficiency, New York Heart Association, Anemia.
dc.subject.nlm.none.fl_str_mv WB 115
description Objective: To characterize iron deficiency patients diagnosed with heart failure and to analyze probable associations between the New York Heart Association (NYHA) scales and the left ventricular ejection fraction (LVEF) in a third level hospital in Bogotá Dc. Methods: A descriptive cross-sectional study was carried out that reviewed retrospective information obtained from the medical records of patients over 18 years of age hospitalized in the Central East Integrated Health Services Subred, Bogotá, Colombia. Results: Of a total of 139 hospitalized patients in the study period, a prevalence of heart failure with reduced LVEF was obtained 45.3%, mean age 53 years, 67.6% men, comorbidities such as atrial fibrillation 23.2%, coronary disease 59%. and dyslipidemia 27.9%, 57.2% patients had iron deficiency. They were found as factors associated with NYHA III and IV; male sex (OR: 2.8; 95% CI: 1.17;6.97), chronic obstructive pulmonary disease (OR: 2.7; 95% CI: 1.03;7.23), iron deficiency ( OR: 1.92; 95% CI: 1.13;3.25). Conclusions: Most of the patients were classified with reduced and slightly reduced heart failure 45%, with anemia and iron deficiency. It was observed that male sex, chronic obstructive pulmonary disease, diagnosis of iron deficiency, total iron >40 mcg/dL, hemoglobin <13g, age younger than 65 years, and a history of coronary disease can be associated with reduced ejection fraction and NYHA classification stages III and IV.
publishDate 2024
dc.date.issued.none.fl_str_mv 2024-11
dc.date.accessioned.none.fl_str_mv 2025-02-12T20:19:56Z
dc.date.available.none.fl_str_mv 2025-02-12T20:19:56Z
dc.type.coar.fl_str_mv http://purl.org/coar/resource_type/c_7a1f
dc.type.local.spa.fl_str_mv Tesis/Trabajo de grado - Monografía - Especialización
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dc.type.driver.none.fl_str_mv info:eu-repo/semantics/bachelorThesis
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dc.identifier.uri.none.fl_str_mv https://hdl.handle.net/20.500.12495/13939
dc.identifier.instname.spa.fl_str_mv instname:Universidad El Bosque
dc.identifier.reponame.spa.fl_str_mv reponame:Repositorio Institucional Universidad El Bosque
dc.identifier.repourl.none.fl_str_mv repourl:https://repositorio.unbosque.edu.co
url https://hdl.handle.net/20.500.12495/13939
identifier_str_mv instname:Universidad El Bosque
reponame:Repositorio Institucional Universidad El Bosque
repourl:https://repositorio.unbosque.edu.co
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[12] Groenveld HF, Januzzi JL, Damman K, van Wijngaarden J, Hillege HL, van Veldhuisen DJ, et al. Anemia and mortality in heart failure patients a systematic review and meta-analysis. J Am Coll Cardiol 2008;52:818–27. https://doi.org/10.1016/j.jacc.2008.04.061.
[13] Ponikowski P, Kirwan B-A, Anker SD, McDonagh T, Dorobantu M, Drozdz J, et al. Ferric carboxymaltose for iron deficiency at discharge after acute heart failure: a multicentre, double-blind, randomised, controlled trial. Lancet (London, England) 2020;396:1895–904. https://doi.org/10.1016/S0140-6736(20)32339-4.
[14] Beck-da-Silva L, Piardi D, Soder S, Rohde LE, Pereira-Barretto AC, de Albuquerque D, et al. IRON-HF study: a randomized trial to assess the effects of iron in heart failure patients with anemia. Int J Cardiol 2013;168:3439–42. https://doi.org/10.1016/j.ijcard.2013.04.181.
[15] Anker SD, Colet JC, Filippatos G, Willenheimer R, Dickstein K, Drexler H, et al. Rationale and design of Ferinject® Assessment in patients with IRon deficiency and chronic Heart Failure (FAIR-HF) study: a randomized, placebo-controlled study of intravenous iron supplementation in patients with and without anaemia. Eur J Heart Fail 2009;11:1084–91. https://doi.org/https://doi.org/10.1093/eurjhf/hfp140.
[16] Ponikowski P, van Veldhuisen DJ, Comin-Colet J, Ertl G, Komajda M, Mareev V, et al. Rationale and design of the CONFIRM-HF study: a double-blind, randomized, placebo-controlled study to assess the effects of intravenous ferric carboxymaltose on functional capacity in patients with chronic heart failure and iron deficiency. ESC Hear Fail 2014;1:52–8. https://doi.org/https://doi.org/10.1002/ehf2.12006.
[17] Ponikowski P, van Veldhuisen DJ, Comin-Colet J, Ertl G, Komajda M, Mareev V, et al. Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency†. Eur Heart J 2015;36:657–68. https://doi.org/10.1093/eurheartj/ehu385.
[18] A. HP, Biykem B, David A, A. AL, J. BJ, M. CM, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary. J Am Coll Cardiol 2022;79:1757–80. https://doi.org/10.1016/j.jacc.2021.12.011.
[19] Pasricha S-R, Tye-Din J, Muckenthaler MU, Swinkels DW. Iron deficiency. Lancet (London, England) 2021;397:233–48. https://doi.org/10.1016/S0140-6736(20)32594-0.
[20] Gomez E. Capitulo 2. Introduccion, epidemiologia de la falla cardiaca e historia de las clinicas de falla cardiaca en Colombia. Rev Colomb Cardiol 2016;23:6–12.
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[22] González-Costello J, Comín-Colet J. Iron deficiency and anaemia in heart failure: understanding the FAIR-HF trial. Eur J Heart Fail 2010;12:1159–62. https://doi.org/10.1093/eurjhf/hfq165.
[23] Deichl A, Edelmann F. Improvement of exercise and functional capacity and quality of life in patients with heart failure by iron therapy. Front Cardiovasc Med 2023;10. https://doi.org/10.3389/fcvm.2023.1025957.
[24] Khan MS, Samman Tahhan A, Vaduganathan M, Greene SJ, Alrohaibani A, Anker SD, et al. Trends in prevalence of comorbidities in heart failure clinical trials. Eur J Heart Fail 2020;22:1032–42. https://doi.org/10.1002/ejhf.1818.
[25] Alcaide-Aldeano A, Garay A, Alcoberro L, Jiménez-Marrero S, Yun S, Tajes M, et al. Iron Deficiency: Impact on Functional Capacity and Quality of Life in Heart Failure with Preserved Ejection Fraction. J Clin Med 2020;9. https://doi.org/10.3390/jcm9041199.
[26] Lee MP, Glynn RJ, Schneeweiss S, Lin KJ, Patorno E, Barberio J, et al. Risk Factors for Heart Failure with Preserved or Reduced Ejection Fraction Among Medicare Beneficiaries: Application of Competing Risks Analysis and Gradient Boosted Model. Clin Epidemiol 2020;12:607–16. https://doi.org/10.2147/CLEP.S253612.
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[36] Ramírez C, Rubio C, Fernández de la Puebla RÁ, Aguilera C, Espejo I, Fuentes F. Significado clínico de los valores elevados de ferritina sérica. Med Clin (Barc) 2004;122:532–4. https://doi.org/https://doi.org/10.1016/S0025-7753(04)74296-7.
[37] Martínez Rodríguez L, Mármol Gutiérrez L. Curso básico sobre hipertensión.Tema 4. Betabloqueantes. Farm Prof 2017;31:20–5.
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[39] Morillas Blasco P, Frutos García A, Bertomeu Martínez V, Valero Parra R, Rodríguez Ortega JA. Efectos de la trimetazidina en la angina microvascular de origen hipertensivo. Hipertens y Riesgo Vasc 2001;18:389–92. https://doi.org/https://doi.org/10.1016/S1889-1837(01)71190-7.
[40] Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. Guía ESC 2020 sobre el diagnóstico y tratamiento de la fibrilación auricular, desarrollada en colaboración de la <span class="elsevierStyleItalic">European Association of Cardio-Thoracic Surgery</span> (EACTS). Rev Española Cardiol 2021;74:437.e1-437.e116. https://doi.org/10.1016/j.recesp.2020.10.022.
[41] Collet J-P, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, et al. Guía ESC 2020 sobre el diagnóstico y tratamiento del síndrome coronario agudo sin elevación del segmento ST. Rev Española Cardiol 2021;74:544.e1-544.e73. https://doi.org/10.1016/j.recesp.2020.12.024.
[42] Ostabal Artigas MI, Fragero Blesa E, Comino García A. los marcapasos cardíacos. Med Integr 2003;41:151–61.
[43] Anchique C V, Fernández RO, Zeballos C. Rehabilitación cardiovascular en la mujer. Rev Colomb Cardiol 2018;25:99–105. https://doi.org/10.1016/j.rccar.2017.11.024.
[44] Silber S, Albertsson P, Avilés FF, Camici PG, Colombo A, Hamm C, et al. Guías de Práctica Clínica sobre intervencionismo coronario percutáneo. Rev Española Cardiol 2005;58:679–728. https://doi.org/10.1157/13076420.
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spelling Toledo Arenas, Jose DanielBaquero Lozano, Gary AndresCalderon Franco, Carlos HernanCalderon franco, Carlos Hernán [0000-0002-9823-8409]2025-02-12T20:19:56Z2025-02-12T20:19:56Z2024-11https://hdl.handle.net/20.500.12495/13939instname:Universidad El Bosquereponame:Repositorio Institucional Universidad El Bosquerepourl:https://repositorio.unbosque.edu.coObjective: To characterize iron deficiency patients diagnosed with heart failure and to analyze probable associations between the New York Heart Association (NYHA) scales and the left ventricular ejection fraction (LVEF) in a third level hospital in Bogotá Dc. Methods: A descriptive cross-sectional study was carried out that reviewed retrospective information obtained from the medical records of patients over 18 years of age hospitalized in the Central East Integrated Health Services Subred, Bogotá, Colombia. Results: Of a total of 139 hospitalized patients in the study period, a prevalence of heart failure with reduced LVEF was obtained 45.3%, mean age 53 years, 67.6% men, comorbidities such as atrial fibrillation 23.2%, coronary disease 59%. and dyslipidemia 27.9%, 57.2% patients had iron deficiency. They were found as factors associated with NYHA III and IV; male sex (OR: 2.8; 95% CI: 1.17;6.97), chronic obstructive pulmonary disease (OR: 2.7; 95% CI: 1.03;7.23), iron deficiency ( OR: 1.92; 95% CI: 1.13;3.25). Conclusions: Most of the patients were classified with reduced and slightly reduced heart failure 45%, with anemia and iron deficiency. It was observed that male sex, chronic obstructive pulmonary disease, diagnosis of iron deficiency, total iron >40 mcg/dL, hemoglobin <13g, age younger than 65 years, and a history of coronary disease can be associated with reduced ejection fraction and NYHA classification stages III and IV.Hospital Santa Clara SubredcentroorienteEspecialista en Medicina InternaEspecializaciónResumen Objetivo: Caracterizar los pacientes diagnosticados con insuficiencia cardiaca ferropénicos y analizar probables asociaciones entre las escalas New York Heart Association (NYHA) y la fracción de eyección del ventrículo izquierdo (FEVI) en un centro hospitalario de tercer nivel de Bogotá Dc. Métodos: Se hizo un estudio descriptivo de corte transversal que revisó información retrospectiva obtenida de los registros de las historias clínicas de pacientes mayores de 18 años hospitalizados en la Subred integrada de servicios de salud centro oriente, Bogotá, Colombia. Resultados: De un total de 139 pacientes hospitalizados en el periodo estudiado se obtuvo una prevalencia Insuficienica cardiaca con FEVI reducida 45.3%, edad promedio de 53 años, 67,6% hombres, comorbilidades como fibrilación auricular 23,2%, enfermedad coronaria 59% y dislipidemia 27,9%, El 57,2% pacientes tenian ferropenia. Se hallaron como factores asociado a NYHA III y IV; sexo masculino (OR: 2,8; IC 95%: 1,17;6,97), enfermedad pulmonar obstructiva cronica (OR: 2,7; IC 95%: 1,03;7,23), Ferropenia (OR: 1,92; IC 95%: 1,13;3,25). Conclusiones: La mayoría de pacientes se clasificaron con insuficiencia cardiaca reducida y levemente reducida 45%, con anemia y ferropenia. Se visualizó que el sexo masculino, enfermedad pulmonar obstructiva cronica, diagnóstico de ferropenia, hierro total > 40 mcg/dL, hemoglobina < 13g, edad menor de 65 años y antecedente de enfermedad coronaria se pueden asociar con fracción de eyección reducida y clasificación NYHA estadios III y IV.application/pdfAttribution-NonCommercial-ShareAlike 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-sa/4.0/Acceso abiertohttps://purl.org/coar/access_right/c_abf2http://purl.org/coar/access_right/c_abf2Insuficiencia cardiaca, Ferropenia, New York Heart Association, Anemia.Keywords: Heart failure, iron deficiency, New York Heart Association, Anemia.WB 115Asociación entre la ferropenia y las escalas funcionales New york Heart Association (NYHA) y la fracción de eyección del ventrículo izquierdo (FEVI) en los pacientes con diagnostico con insuficiencia cardiaca descompensadaAssociation between iron deficiency and the New York Heart Association (NYHA) functional scales and left ventricular ejection fraction (LVEF) in patients diagnosed with decompensated heart failureEspecialización en Medicina InternaUniversidad El BosqueFacultad de MedicinaTesis/Trabajo de grado - Monografía - Especializaciónhttps://purl.org/coar/resource_type/c_7a1fhttp://purl.org/coar/resource_type/c_7a1finfo:eu-repo/semantics/bachelorThesishttps://purl.org/coar/version/c_ab4af688f83e57aa[1] Urbich M, Globe G, Pantiri K, Heisen M, Bennison C, Wirtz HS, et al. A Systematic Review of Medical Costs Associated with Heart Failure in the USA (2014-2020). Pharmacoeconomics 2020;38:1219–36. https://doi.org/10.1007/s40273-020-00952-0.[2] Ambrosy AP, Fonarow GC, Butler J, Chioncel O, Greene SJ, Vaduganathan M, et al. The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries. J Am Coll Cardiol 2014;63:1123–33. https://doi.org/10.1016/j.jacc.2013.11.053.[3] Ezekowitz JA, McAlister FA, Armstrong PW. Anemia is common in heart failure and is associated with poor outcomes: insights from a cohort of 12 065 patients with new-onset heart failure. Circulation 2003;107:223–5. https://doi.org/10.1161/01.cir.0000052622.51963.fc.[4] Horwich TB, Fonarow GC, Hamilton MA, MacLellan WR, Borenstein J. Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failure. 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Int J Cardiol 2013;168:3439–42. https://doi.org/10.1016/j.ijcard.2013.04.181.[15] Anker SD, Colet JC, Filippatos G, Willenheimer R, Dickstein K, Drexler H, et al. Rationale and design of Ferinject® Assessment in patients with IRon deficiency and chronic Heart Failure (FAIR-HF) study: a randomized, placebo-controlled study of intravenous iron supplementation in patients with and without anaemia. Eur J Heart Fail 2009;11:1084–91. https://doi.org/https://doi.org/10.1093/eurjhf/hfp140.[16] Ponikowski P, van Veldhuisen DJ, Comin-Colet J, Ertl G, Komajda M, Mareev V, et al. Rationale and design of the CONFIRM-HF study: a double-blind, randomized, placebo-controlled study to assess the effects of intravenous ferric carboxymaltose on functional capacity in patients with chronic heart failure and iron deficiency. ESC Hear Fail 2014;1:52–8. https://doi.org/https://doi.org/10.1002/ehf2.12006.[17] Ponikowski P, van Veldhuisen DJ, Comin-Colet J, Ertl G, Komajda M, Mareev V, et al. 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Eur J Heart Fail 2010;12:1159–62. https://doi.org/10.1093/eurjhf/hfq165.[23] Deichl A, Edelmann F. Improvement of exercise and functional capacity and quality of life in patients with heart failure by iron therapy. Front Cardiovasc Med 2023;10. https://doi.org/10.3389/fcvm.2023.1025957.[24] Khan MS, Samman Tahhan A, Vaduganathan M, Greene SJ, Alrohaibani A, Anker SD, et al. Trends in prevalence of comorbidities in heart failure clinical trials. Eur J Heart Fail 2020;22:1032–42. https://doi.org/10.1002/ejhf.1818.[25] Alcaide-Aldeano A, Garay A, Alcoberro L, Jiménez-Marrero S, Yun S, Tajes M, et al. Iron Deficiency: Impact on Functional Capacity and Quality of Life in Heart Failure with Preserved Ejection Fraction. J Clin Med 2020;9. https://doi.org/10.3390/jcm9041199.[26] Lee MP, Glynn RJ, Schneeweiss S, Lin KJ, Patorno E, Barberio J, et al. Risk Factors for Heart Failure with Preserved or Reduced Ejection Fraction Among Medicare Beneficiaries: Application of Competing Risks Analysis and Gradient Boosted Model. Clin Epidemiol 2020;12:607–16. https://doi.org/10.2147/CLEP.S253612.[27] Diccionario Mosby de Medicina, Enfermería y Ciencias de la Salud, 2 vols.(Spanish Edition) 6th Edición. páginas 2.476 . ISBN: 9788481746327. 2003 n.d.[28] Pava-Molano LF, Perafán-Bautista PE. Generalidades de la fibrilación auricular. Rev Colomb Cardiol 2016;23:5–8. https://doi.org/10.1016/j.rccar.2016.10.003.[29] CITADO. Intervención en tabaquismo en los diferentes ámbitos. Man Enfermeria, Prev y Rehabil Card 51AD:Pag. 51-64.[30] Stevens PE, Levin A. Evaluation and management of chronic kidney disease: Synopsis of the kidney disease: Improving global outcomes 2012 clinical practice guideline. Ann Intern Med 2013;158:825–30. https://doi.org/10.7326/0003-4819-158-11-201306040-00007.[31] PIERA FERNÁNDEZ M. 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Rev Española Cardiol 2005;58:679–728. https://doi.org/10.1157/13076420.https://actamedicacolombiana.com/ojs/index.php/actamed/article/view/3091/2172LICENSElicense.txtlicense.txttext/plain; charset=utf-82000https://repositorio.unbosque.edu.co/bitstreams/811e43e0-ba07-4dd0-9698-928289e29fa7/download17cc15b951e7cc6b3728a574117320f9MD52Carta de autorizacion.pdfapplication/pdf210851https://repositorio.unbosque.edu.co/bitstreams/e253b01f-3437-4083-9021-437bc3da7118/downloadd27d5e2d0d49f4d35ed7f0d49a48ddcaMD55Anexo 1 Acta de aprobacion.pdfapplication/pdf309104https://repositorio.unbosque.edu.co/bitstreams/cf94cd01-08be-4328-8bb6-fb16f681c4ed/download87cc666529781ff53aa4e97ea836a0c3MD56ORIGINALTrabajo de grado.pdfTrabajo de grado.pdfapplication/pdf536144https://repositorio.unbosque.edu.co/bitstreams/c61b55b0-763d-4382-8562-0ef7c9b97c8c/downloadf533c4f06977d5069d0f18746a024fa6MD53CC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-81160https://repositorio.unbosque.edu.co/bitstreams/01844c22-8097-4a4b-8e6e-70704c999f1d/download5643bfd9bcf29d560eeec56d584edaa9MD54TEXTTrabajo de grado.pdf.txtTrabajo de grado.pdf.txtExtracted texttext/plain90016https://repositorio.unbosque.edu.co/bitstreams/c7fe03f3-47d6-4d52-bfcf-c9979a58421f/download2b80d523eb0ebec03c612dc5c033938cMD57THUMBNAILTrabajo de grado.pdf.jpgTrabajo de grado.pdf.jpgGenerated Thumbnailimage/jpeg2935https://repositorio.unbosque.edu.co/bitstreams/959818bc-b2c9-4d7f-aab8-a1fbfacdbf08/download4b86c16b0a14b7ce8996c202c190958fMD5820.500.12495/13939oai:repositorio.unbosque.edu.co:20.500.12495/139392025-02-13 03:06:12.317http://creativecommons.org/licenses/by-nc-sa/4.0/Attribution-NonCommercial-ShareAlike 4.0 Internationalopen.accesshttps://repositorio.unbosque.edu.coRepositorio Institucional Universidad El Bosquebibliotecas@biteca.comTGljZW5jaWEgZGUgRGlzdHJpYnVjacOzbiBObyBFeGNsdXNpdmEKClBhcmEgcXVlIGVsIFJlcG9zaXRvcmlvIGRlIGxhIFVuaXZlcnNpZGFkIEVsIEJvc3F1ZSBhIHB1ZWRhIHJlcHJvZHVjaXIgeSBjb211bmljYXIgcMO6YmxpY2FtZW50ZSBzdSBkb2N1bWVudG8gZXMgbmVjZXNhcmlvIGxhIGFjZXB0YWNpw7NuIGRlIGxvcyBzaWd1aWVudGVzIHTDqXJtaW5vcy4gUG9yIGZhdm9yLCBsZWEgbGFzIHNpZ3VpZW50ZXMgY29uZGljaW9uZXMgZGUgbGljZW5jaWE6CgoxLiBBY2VwdGFuZG8gZXN0YSBsaWNlbmNpYSwgdXN0ZWQgKGVsIGF1dG9yL2VzIG8gZWwgcHJvcGlldGFyaW8vcyBkZSBsb3MgZGVyZWNob3MgZGUgYXV0b3IpIGdhcmFudGl6YSBhIGxhIFVuaXZlcnNpZGFkIEVsIEJvc3F1ZSBlbCBkZXJlY2hvIG5vIGV4Y2x1c2l2byBkZSBhcmNoaXZhciwgcmVwcm9kdWNpciwgY29udmVydGlyIChjb21vIHNlIGRlZmluZSBtw6FzIGFiYWpvKSwgY29tdW5pY2FyIHkvbyBkaXN0cmlidWlyIHN1IGRvY3VtZW50byBtdW5kaWFsbWVudGUgZW4gZm9ybWF0byBlbGVjdHLDs25pY28uCgoyLiBUYW1iacOpbiBlc3TDoSBkZSBhY3VlcmRvIGNvbiBxdWUgbGEgVW5pdmVyc2lkYWQgRWwgQm9zcXVlIHB1ZWRhIGNvbnNlcnZhciBtw6FzIGRlIHVuYSBjb3BpYSBkZSBlc3RlIGRvY3VtZW50byB5LCBzaW4gYWx0ZXJhciBzdSBjb250ZW5pZG8sIGNvbnZlcnRpcmxvIGEgY3VhbHF1aWVyIGZvcm1hdG8gZGUgZmljaGVybywgbWVkaW8gbyBzb3BvcnRlLCBwYXJhIHByb3DDs3NpdG9zIGRlIHNlZ3VyaWRhZCwgcHJlc2VydmFjacOzbiB5IGFjY2Vzby4KCjMuIERlY2xhcmEgcXVlIGVsIGRvY3VtZW50byBlcyB1biB0cmFiYWpvIG9yaWdpbmFsIHN1eW8geS9vIHF1ZSB0aWVuZSBlbCBkZXJlY2hvIHBhcmEgb3RvcmdhciBsb3MgZGVyZWNob3MgY29udGVuaWRvcyBlbiBlc3RhIGxpY2VuY2lhLiBUYW1iacOpbiBkZWNsYXJhIHF1ZSBzdSBkb2N1bWVudG8gbm8gaW5mcmluZ2UsIGVuIHRhbnRvIGVuIGN1YW50byBsZSBzZWEgcG9zaWJsZSBzYWJlciwgbG9zIGRlcmVjaG9zIGRlIGF1dG9yIGRlIG5pbmd1bmEgb3RyYSBwZXJzb25hIG8gZW50aWRhZC4KCjQuIFNpIGVsIGRvY3VtZW50byBjb250aWVuZSBtYXRlcmlhbGVzIGRlIGxvcyBjdWFsZXMgbm8gdGllbmUgbG9zIGRlcmVjaG9zIGRlIGF1dG9yLCBkZWNsYXJhIHF1ZSBoYSBvYnRlbmlkbyBlbCBwZXJtaXNvIHNpbiByZXN0cmljY2nDs24gZGVsIHByb3BpZXRhcmlvIGRlIGxvcyBkZXJlY2hvcyBkZSBhdXRvciBwYXJhIG90b3JnYXIgYSBsYSBVbml2ZXJzaWRhZCBFbCBCb3NxdWUgbG9zIGRlcmVjaG9zIHJlcXVlcmlkb3MgcG9yIGVzdGEgbGljZW5jaWEsIHkgcXVlIGVzZSBtYXRlcmlhbCBjdXlvcyBkZXJlY2hvcyBzb24gZGUgdGVyY2Vyb3MgZXN0w6EgY2xhcmFtZW50ZSBpZGVudGlmaWNhZG8geSByZWNvbm9jaWRvIGVuIGVsIHRleHRvIG8gY29udGVuaWRvIGRlbCBkb2N1bWVudG8gZW50cmVnYWRvLgoKNS4gU2kgZWwgZG9jdW1lbnRvIHNlIGJhc2EgZW4gdW5hIG9icmEgcXVlIGhhIHNpZG8gcGF0cm9jaW5hZGEgbyBhcG95YWRhIHBvciB1bmEgYWdlbmNpYSB1IG9yZ2FuaXphY2nDs24gZGlmZXJlbnRlIGRlIGxhIFVuaXZlcnNpZGFkIEVsIEJvc3F1ZSwgc2UgcHJlc3Vwb25lIHF1ZSBzZSBoYSBjdW1wbGlkbyBjb24gY3VhbHF1aWVyIGRlcmVjaG8gZGUgcmV2aXNpw7NuIHUgb3RyYXMgb2JsaWdhY2lvbmVzIHJlcXVlcmlkYXMgcG9yIGVzdGUgY29udHJhdG8gbyBhY3VlcmRvLgoKNi4gVW5pdmVyc2lkYWQgRWwgQm9zcXVlIGlkZW50aWZpY2Fyw6EgY2xhcmFtZW50ZSBzdS9zIG5vbWJyZS9zIGNvbW8gZWwvbG9zIGF1dG9yL2VzIG8gcHJvcGlldGFyaW8vcyBkZSBsb3MgZGVyZWNob3MgZGVsIGRvY3VtZW50bywgeSBubyBoYXLDoSBuaW5ndW5hIGFsdGVyYWNpw7NuIGRlIHN1IGRvY3VtZW50byBkaWZlcmVudGUgYSBsYXMgcGVybWl0aWRhcyBlbiBlc3RhIGxpY2VuY2lhLgo=

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