RESUMEN
The use of a starfruit dietary fiber concentrate (SDFC) as a novel ingredient in Vienna sausages was investigated. A constrained mixture design was followed to evaluate the effect of different proportions of SDFC (0-10%), pork meat (0-100%) and turkey meat (0-100%) on the shear force, shrinkage, color, residual nitrite, moisture and polyphenol contents of sausages. Moreover, a chemical, physical and sensory characterization of the optimized formulations was performed. The cubic model equations demonstrated that the SDFC in mixture with pork or turkey meat had a reducing effect on nitrites, moisture, shear force and shrinkage, while there was an increase on the polyphenol concentration as the increase of SDFC proportion in the formulations. The optimization resulted in Vienna-type sausages formulated with a ternary mixture of pork/turkey meat and high SDFC proportion (7.4-8.4%). These products had high total dietary fiber content (11.04-17.79%) and antioxidant polyphenols, low residual nitrite content, shrinkage and red color. They presented good taste, color and texture attributes, and were sensory acceptable. This study demonstrated that enrichment of Vienna-type sausages with SDFC in mixture with pork/turkey meat is a way to obtain potential functional meat products with high antioxidant dietary fiber content, reduced in nitrites, and good physical and sensory properties.
RESUMEN
Fresh produce often harbors a great number of microorganisms; hence, its growing demand may constitute a risk for consumers. The aim of this study was to evaluate the efficacy of several disinfection procedures against enterotoxigenic Escherichia coli (ETEC) inoculated on tomato fruits and the conservation of the antioxidant properties of these disinfected fruits. Fruits were immersed for 5 or 10min in oregano or thyme essential oil dispersions (5, 10ppm), with or without ultrasound treatment. Antioxidant activity of disinfected fruits was determined as the ability to scavenge 2,2-diphenyl-1-pricrylhydrazyl (DPPH) radicals and was reported as percentage of inhibition (%I). The most efficient disinfectant treatments showing significant differences (p≤.05) between the reductions log10 CFU/g (S) of ETEC were those using 10ppm oregano for 10min, with S=3.05 in individual treatments and S=4.03 in mixed treatments. The highest %I was obtained with individual sonication treatments (69.52 and 72.48), while in combined treatments the %I values increased with thyme oil 5ppm and ultrasound for 5min (51.27%) and 10min (53.31%).
Asunto(s)
Antioxidantes/farmacología , Desinfección/métodos , Escherichia coli Enterotoxigénica/efectos de los fármacos , Aceites Volátiles/farmacología , Origanum/química , Aceites de Plantas/farmacología , Solanum lycopersicum/microbiología , Sonicación , Thymus (Planta)/química , Desinfectantes , Emulsiones , Microbiología de Alimentos , Aceites Volátiles/aislamiento & purificación , Oxidación-Reducción , Hojas de la Planta/química , Aceites de Plantas/aislamiento & purificaciónRESUMEN
Species of Gila comprise a heterogeneous and widespread group of freshwater fishes inhabiting drainage systems of western North America. The classification of species of Gila and relatives has been complicated and sometimes compromised by differences in body shapes, sizes, habitats, variable taxonomic placement by early taxonomists, and instances of hypothesized hybridization. While most attention on Gila has focused on hybridization in USA, little is actually know about their intra and intergeneric relationships. We present a molecular phylogeny using 173 specimens for all 19 recognized species of Gila, covering their entire distributions in 31 major drainages. Using one mitochondrial and three nuclear genes, specimens of Gila were analyzed with 10 other North American genera that comprise the Revised Western Clade. All analyses identified most species of Gila in a lineage that always included the monotypic genera Moapa and Acrocheilus, and we recommend the synonymy of both genera with Gila. The composition of this Gila lineage varied depending on the genes analyzed. Within the Gila lineage, similar morphotypes (forms adapted to fast currents vs. general forms) were not resolved as closest relatives. Analyses of mitochondrial DNA resolved all species of Gila from Mexico in reciprocally monophyletic clades except G. modesta. Most species of Gila in the USA were nested in 3 major clades, potentially indicating some level of historic or contemporary interspecific hybridization. Herein, we redefine the ranges for all species of Gila in Mexico. Relevant taxonomic and conservation implications stemming from the results are discussed.
Asunto(s)
Cyprinidae/genética , Filogenia , Animales , Cyprinidae/clasificación , ADN Mitocondrial/genética , Evolución Molecular , Hibridación Genética , México , Mitocondrias/genética , Análisis de Secuencia de ADN , Sudoeste de Estados UnidosRESUMEN
Boronic acids form diester bonds with cis-hydroxyl groups in carbohydrates. The formation of these adducts could impair the physical and chemical properties of precursors, even their biological activity. Two carbohydrate derivatives from d-fructose and d-arabinose and phenylboronic acid were synthesized in a straightforward one-step procedure and chemically characterized via spectroscopy and X-ray diffraction crystallography. Additionally, an acute toxicity test was performed to determine their lethal dose 50 (LD50) values by using Lorke's method. Analytical chemistry assays confirmed the formation of adducts by the generation of diester bonds with the ß-d-pyranose of carbohydrates, including signals corresponding to the formation of new bonds, such as the stretching of B-O bonds. NMR spectra yielded information about the stereoselectivity in the synthesis reaction: Just one signal was found in the range for the anomeric carbon in the 13C NMR spectra of both adducts. The acute toxicity tests showed that the LD50 value for both compounds was 1265 mg/kg, while the effective dose 50 (ED50) for sedation was 531 mg/kg. However, differences were found in the onset and lapse of sedation. For example, the arabinose derivative induced sedation for more than 48 h at 600 mg/kg, while the fructose derivative induced sedation for less than 6 h at the same dose without the death of the mice. Thus, we report for the first time two boron-containing carbohydrate derivatives inducing sedation after intraperitoneal administration. They are bioactive and highly safe agents. Further biological evaluation is desirable to explore their medical applications.
RESUMEN
The aim of this work was to evaluate the influence of high intensity ultrasound (HIUS) treatment on the molecular conformation of whey protein isolated (WPI) as a previous step for complex coacervation with iota carrageenan (IC) and its effect on the surface functional properties of complex coacervates (CC). Both biopolymers were hydrated (1% w/w) separately. A WPI suspension was treated with an ultrasonic bath (40â kHz, 600â W, 30 and 60â min, 100% amplitude). A non-sonicated protein was used as a control. Coacervation was achieved by mixing WPI and IC dispersions (10â min). FTIR-ATR analysis (400-4000â cm-1) detected changes after sonication on WPI secondary structure (1600-1700â cm-1), electrostatic interaction between WPI and IC by electronegative IC charged groups like sulfate (1200-1260â cm-1), anhydrous oxygen of the 3.6 anhydro-D-galactose (940-1066â cm-1) and the electropositive regions of WPI. Rheology results showed pseudoplastic behavior of both IC and WPI-IC with a significant change in viscosity level. Further, HIUS treatment had a positive effect on the emulsifying properties of the WPI-IC coacervates, increasing the time foaming (30â min) and emulsion stability (1â month) percentage. HIUS and complex coacervation proved to be an efficient tool to improve the surface functional properties of WPI.
Asunto(s)
Carragenina , Carragenina/química , Proteína de Suero de Leche/química , Biopolímeros/química , Viscosidad , Propiedades de Superficie , Emulsiones/químicaRESUMEN
Tomato is one of the most important fruits worldwide. It is widely consumed due to its sensory and nutritional attributes. However, like many other industrial crops, it is affected by biotic and abiotic stress factors, reducing its metabolic and physiological processes. Tomato plants possess different mechanisms of stress responses in which hormones have a pivotal role. They are responsible for a complex signaling network, where the antioxidant system (enzymatic and non-enzymatic antioxidants) is crucial for avoiding the excessive damage caused by stress factors. In this sense, it seems that hormones such as ethylene, auxins, brassinosteroids, and salicylic, jasmonic, abscisic, and gibberellic acids, play important roles in increasing antioxidant system and reducing oxidative damage caused by different stressors. Although several studies have been conducted on the stress factors, hormones, and primary metabolites of tomato plants, the effect of endogenous and/or exogenous hormones on the secondary metabolism is still poorly studied, which is paramount for tomato growing management and secondary metabolites production. Thus, this review offers an updated overview of both endogenous biosynthesis and exogenous hormone application in the antioxidant system of tomato plants as a response to biotic and abiotic stress factors.
RESUMEN
Aiming at producing a reduced fat cheese (RFC) as an alternative to full-fat Panela cheese, a highly consumed fresh Mexican dairy product, thermosonication (TS) processes (24 kHz, 400 W nominal power, 2, 4 and 6 min; 50, 55 and 60 °C) were evaluated to treat WPC (80% protein) blended with reduced-fat milk (1 and 2% fat), which were later LTLT pasteurized. TS blends were compared in terms of their technological properties (water holding capacity-WPC, gel firmness- GF, color, pH and titratable acidity) with those of a regular full fat (3%) LTLT pasteurized milk used as a control. Afterwards, a regression analysis was carried out with the obtained data in order to select the most appropriate conditions for cheesemaking purposes (similar GF, higher WHC with respect to the control), minimize both fat content and TS treatment duration to minimize energy expenses. According to these restrictions, the selected conditions were 1.5% fat milk-WPC blend, TS treated at 60 °C for 120 s; 1% fat milk-WPC blend, TS treated at 50 °C for 120 s and 1% fat milk-WPC blend, 50 °C for 144 s, which allowed preparing low fat cheeses (LFCs). These TS treatments were applied in a larger scale to elaborate Panela-type LFCs comparing different technological properties (cheese yield, syneresis, water content, texture profile analysis, color and titratable acidity) with those of a full fat variety, at day 1 and during 14 days of refrigerated storage. Results showed similar texture profiles of LFC cheeses and full fat milk cheeses throughout their storage period with significant changes in composition parameters (higher moisture, protein and salt contents, with low fat percentages), syneresis, selected color parameters (hue, b*), with no observed changes in cheese yield, TA and pH during cheese storage. These promising results are encouraging to develop LFCs with no physicochemical or technological defects using novel processing techniques that may help reducing calorie consumption without compromising sensory acceptability.
Asunto(s)
Queso/análisis , Grasas de la Dieta/análisis , Calidad de los Alimentos , Sonicación , Temperatura , Proteína de Suero de Leche/químicaRESUMEN
In this paper we analyse the degree of concordance in species richness and taxonomic distinctness (diversity) patterns among different freshwater taxonomic groups in order to test three long held patterns described in Mexican freshwater biogeography: 1. The aquatic biota of Mexico includes two distinct faunas, a rich Neotropical component in the south and a south-eastern region and a less rich Nearctic component towards central and northern latitudes of the country. 2. A hotspot of species richness and diversity has been recorded in the Usumacinta, including the Yucatan Peninsula. 3. The presence of two distinct biotas in Mexico, an eastern one distributed along the Gulf of Mexico slope, and a western one associated to the Pacific versant. We use species richness and taxonomic distinctness to explore patterns of diversity and how these patterns change between zoogeographical regions. This paper points out a clear separation between Neotropical and Nearctic drainage basins but also between eastern (Gulf of Mexico) and western (Pacific) drainage basins. Present data gives additional empirical support from freshwater biota for three long held beliefs regarding distributional patterns of the Mexican biota. The neotropical basins of Mexico are generally host to a richest and more diversified fauna, that includes more families, genera and species, compared to the less rich and less diverse fauna in the nearctic basins.
Asunto(s)
Biodiversidad , Biota/fisiología , Peces/clasificación , Animales , Ecosistema , Agua Dulce , Geografía , MéxicoRESUMEN
La creciente demanda de frutos frescos puede constituir un riesgo para la salud de los consumidores, teniendo en cuenta la gran variedad de microorganismos que estos suelen albergar. El objetivo del presente estudio fue evaluar la eficacia de varios procedimientos de desinfección sobre Escherichia coli enterotoxigénica (enterotoxigenic E. coli [ETEC]) inoculada en tomate y la conservación de las propiedades antioxidantes de los frutos desinfectados. Los frutos fueron sumergidos durante 5 o 10min en dispersiones de aceites esenciales de orégano o tomillo (5 o 10ppm), combinados o no con la aplicación de ultrasonido. La actividad antioxidante se determinó por la neutralización del radical 2,2-difenil-1-pricrilhidrazil (DPPH) y se reportó como porcentaje de inhibición (%I). Los tratamientos de desinfección más eficaces para una significativa reducción log10 UFG/g (S) de ETEC fueron con 10ppm de aceite de orégano durante 10min, con reducciones S=3,05 en tratamientos individuales y S=4,03 en mixtos. Los %I más altos se lograron con tratamientos individuales con sonicación (69,52 y 72,48) y en tratamientos combinados con aceite de tomillo 5ppm y ultrasonido durante 5 y 10min, con valores de 51,27 y 53,31%, respectivamente
Fresh produce often harbors a great number of microorganisms; hence, its growing demand may constitute a risk for consumers. The aim of this study was to evaluate the efficacy of several disinfection procedures against enterotoxigenic Escherichia coli (ETEC) inoculated on tomato fruits and the conservation of the antioxidant properties of these disinfected fruits. Fruits were immersed for 5 or 10min in oregano or thyme essential oil dispersions (5, 10ppm), with or without ultrasound treatment. Antioxidant activity of disinfected fruits was determined as the ability to scavenge 2,2-diphenyl-1-pricrylhydrazyl (DPPH) radicals and was reported as percentage of inhibition (%I). The most efficient disinfectant treatments showing significant differences (p≤.05) between the reductions log10 CFU/g (S) of ETEC were those using 10ppm oregano for 10min, with S=3.05 in individual treatments and S=4.03 in mixed treatments. The highest %I was obtained with individual sonication treatments (69.52 and 72.48), while in combined treatments the %I values increased with thyme oil 5ppm and ultrasound for 5min (51.27%) and 10min (53.31%)
Asunto(s)
Desinfección/métodos , Solanum lycopersicum/microbiología , Escherichia coli Enterotoxigénica/efectos de los fármacos , Antioxidantes/análisis , Ultrasonido/métodos , Aceites Volátiles/farmacocinética , Solanum lycopersicum/inmunología , Escherichia coli Enterotoxigénica/metabolismoRESUMEN
Se realizó un estudio de casos y controles de 121 niños intervenidos por cirugía cardíaca con circulación extracorpórea en el Cardiocentro de Santiago de Cuba (de 336 en total), en el período 1987- 2004, a fin de identificar los factores asociados que influyeron en la aparición de complicaciones neurológicas graves (en 11 de los catalogados como casos), entre los cuales figuraron: tipo de cardiopatía (adquirida) y tiempo total de perfusión (prolongado); los escogidos como controles, no complicados, sumaron 110. Desde el punto de vista significativo se consideraron importantes las variables: complejidad de la operación, tiempo de paro anóxico y temperatura utilizada en la circulación extracorpórea, cuya presencia, tanto aisladas como asociadas, debe alertar al equipo médico sobre la posible ocurrencia de dichas complicaciones. Este estudio es el primero de su tipo efectuado en Cuba
A case-control study was carried out in 121 children who underwent heart surgery with cardiopulmonary bypass at the Cardiology Center of Santiago de Cuba (of 336 total), in the period 1987 - 2004, in order to identify associated factors that influenced the occurrence of serious neurological complications (in 11 of those identified as cases), among which were: type of heart disease (acquired) and total time of perfusion (prolonged). Those chosen as controls without complications added up to 110. The following variables were considered statistically significant: complexity of the operation, time of anoxic arrest and temperature used in cardiopulmonary bypass. The presence of both isolated and associated variables should alert the medical team to the possible occurrence of such complications. This study is the first of its kind made in Cuba
Asunto(s)
Humanos , Niño , Procedimientos Quirúrgicos Cardíacos , Circulación Extracorporea , Complicaciones Posoperatorias , Cirugía TorácicaRESUMEN
Se realizó un estudio descriptivo de 40 pacientes operados por aneurismas de la aorta ascendente en el Cardiocentro de Santiago de Cuba desde enero de 1985 hasta diciembre del 2005. La disección aórtica resultó ser la causa más común, en tanto la técnica de Bentall-De Bono y la interposición de prótesis vasculares fueron las intervenciones más efectuadas. En todos los casos se ejecutó hipotermia y en 30 por ciento se requirió de parada circulatoria. Asimismo, en 80 por ciento de los pacientes se presentaron complicaciones peroperatorias, que provocaron la muerte de 5 de ellos (12,5 ), mientras que otros 10 (28,5 ) fallecieron durante el período posoperatorio, para una mortalidad operatoria global de 37,5. El síndrome de bajo gasto cardíaco y las arritmias fueron las complicaciones más halladas. Se concluyó que las operaciones realizadas fueron complejas y el índice de complicaciones se consideró elevado, de forma que generaron una mortalidad particularmente alta, con estadías hospitalarias prolongadas.
A descriptive study of 40 patients with aneurysms of the ascending aorta was carried out in the Cardiocentre at Santiago de Cuba from January, 1985 to December, 2005. The aortic dissection was the most common cause, while the technique of Bentall-De Bono and placing of the vascular prostheses were the most used interventions. In all the cases hypothermia was applied and in 30 circulatory arrest was required. Also, there were peroperative complications in 80 of patients, which caused death in 5 of them (12,5), while others 10 (28,5) died during the postoperative period, for an overall surgical mortality of 37,5. The syndrome of low cardiac output and the arrhythmias were the most found complications. It was concluded that the performed surgeries were complex and the rate of complications was considered high, so that they provoked a particularly high mortality, with prolonged hospital stays.
Asunto(s)
Humanos , Masculino , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/mortalidad , Servicio de Cardiología en HospitalRESUMEN
Se hizo un estudio retrospectivo de 342 operados del corazón con circulación extracorpórea (CEC) en el Centro de Cirugía Cardiovascular de Santiago de Cuba desde enero de 1987 hasta diciembre del 2004. De ellos, 11 (3,2 por ciento) presentaron alteraciones neurológicas, con el estado de coma en primer lugar (45,4 por ciento), el edema cerebral en segundo (36,4 por ciento ) y las alteraciones de la personalidad en tercero (18,2 por ciento ); de ese total, 7 fallecieron (63,7 por ciento), pero solo 3 (27,0 por ciento) por causas neurológicas como tales, que a su vez representaron 0,8 7 por ciento en todos los pacientes operados. Se analizaron los factores de riesgo peroperatorios que pudieron incidir en estas alteraciones, así como los valores mantenidos durante la CEC y el tipo de proceder quirúrgico ejecutado. Las alteraciones neurológicas primaron en las afecciones cardíacas adquiridas
Asunto(s)
Humanos , Niño , Circulación Extracorporea , Cirugía TorácicaRESUMEN
Se realizó un estudio retrospectivo de 652 pacientes operados del corazón con circulación extracorpórea (CEC) durante el quinquenio comprendido de enero del 2001 a diciembre del 2005 en el Centro de Cirugía Cardiovascular de Santiago de Cuba. La investigación reveló que 48 de ellos (7,3 por ciento) presentaron alteraciones neurológicas, con predominio del edema cerebral (35,4 por ciento), los trastornos de la personalidad (27,0por ciento ) y el estado de coma (23,0 por ciento), que en su conjunto provocaron la muerte de 12 de ellos (25,0 por ciento), pues solo 3 fallecieron por causas neurológicas. Se analizaron los factores de riesgo peroperatorios que pudieron repercutir sobre la ocurrencia de estas manifestaciones clínicas, así como los valores de la circulación extracorpórea y el tipo de proceder quirúrgico aplicado
Asunto(s)
Humanos , Masculino , Femenino , Puente Cardiopulmonar , Procedimientos Quirúrgicos Cardiovasculares , Circulación Extracorporea , Enfermedades del Sistema Nervioso , Factores de RiesgoRESUMEN
Se hizo un estudio retrospectivo de 37 pacientes operados por aneurismas de aorta ascendente en el Cardiocentro de Santiago de Cuba desde enero de 1987 hasta diciembre del 2004, de los cuales 30 eran del sexo masculino, con predominio del grupo de 41 a 50 años, de la disección aórtica como causa más frecuente y de las intervenciones electivas y urgentes en casi idéntica proporción. Se utilizaron varias técnicas quirúrgicas según el tipo de aneurisma, pero fundamentalmente la de Bentall DeBono, la sustitución vascular y la de Wheat. Once pacientes requirieron un paro circulatorio para poder acceder al aneurisma, 5 fallecieron durante el acto operatorio y 23 presentaron complicaciones posquirúrgicas. La supervivencia en general fue de 64,9 por ciento.
Asunto(s)
Masculino , Adulto , Humanos , Femenino , Aorta , Aneurisma de la Aorta , Procedimientos Quirúrgicos Cardiovasculares , Análisis de SupervivenciaRESUMEN
Se presentan los resultados de la circulación extracorpórea en 182 pacientes operados con este proceder técnico en el Cardiocentro de Santiago de Cuba durante el 2004, y aunque fueron satisfactorios con el uso de la cardioplejía fría cristaloide por vía anterógrada en todos los integrantes de la casuística, se recomienda comenzar a utilizar la cardioplejía sanguínea por la eficacia que le atribuyen otros grupos de trabajo.
Asunto(s)
Humanos , Procedimientos Quirúrgicos Cardiovasculares , Circulación Extracorporea , Calidad de la Atención de SaludRESUMEN
En el presente artículo se revisan los hallazgos clínicos, anatomo patológicos y de imágenes diagnósticas en las colecistosis hiperplásicas. Se hace énfasis en la utilidad de la ecografía para su diagnóstico que se definen las pautas de manejo en estos pacientes
Asunto(s)
Humanos , Colecistografía/estadística & datos numéricos , Endometriosis , Endometriosis/patologíaRESUMEN
Se realizó un estudio descriptivo, lineal y retrospectivo de 5 a 15 años, operados con circulación extracorpórea en el Cardiocentro de Santiago de Cuba desde enero de 1987 hasta diciembre de 1991. Este grupo constituyó el 59,0 por ciento de todos los niños operados en dicho centro durante esa etapa, de los cuales fallecieron 10, para el 5,9 por ciento de los intervenidos con circulación extracorpórea y en el 3,4 por ciento del total general (286), se halló un predominio del sexo femenino, así como cifras similares de niños en grupos etarios de 5 a 10 y 11 a 15 años. Se relacionaron los diagnósticos y causas de muerte de cada uno de ellos y se analizaron los elementos vinculados con la circulación extracorpórea, a saber: tipo de oxigeneador utilizado y parámetros fundamentales controlados
Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Adolescente , Circulación Extracorporea , Cardiopatías/cirugía , Epidemiología Descriptiva , Estudios RetrospectivosRESUMEN
Tha case of a 55 year old man who presented with severe global headache 8 hours after having been drinking heavily, and who over a two hour period developed deep coma and flaccid paralysis of all four extremities is reported. A CT scan of the brain was normal; however, on Magnetic Resonance Imaging (MRI) extensive hyperintense areas in the brain stem, mainly in the pons, were easily identified. Based upon the clinical and MRI findings a diagnosis of Central Pontine Myelinolysis was made. Following several months of supportive therapy the patient partially recovered and was able to leave the hospital.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Mielinólisis Pontino Central/cirugía , Mielinólisis Pontino Central/clasificación , Mielinólisis Pontino Central/complicaciones , Mielinólisis Pontino Central/diagnóstico , Mielinólisis Pontino Central/epidemiología , Mielinólisis Pontino Central/etiología , Mielinólisis Pontino Central/fisiopatología , Mielinólisis Pontino Central/historia , Mielinólisis Pontino Central/patología , Mielinólisis Pontino Central/prevención & control , Mielinólisis Pontino Central/tratamiento farmacológico , Mielinólisis Pontino Central , Mielinólisis Pontino Central/terapiaRESUMEN
Se realiza un estudio descriptivo, lineal y retrospectivo de 36 pacientes operados por enfermedades valvulares en el Cardiocentro de Santiago de Cuba, durante el período comprendido de enero de 1987 a diciembre de 1989. Se incluyen en la serie 17 niños con lesiones mitrales, 10 con pulmonares, 8 con aórticas y 1 con tricuspídea, pero se excluyen las lesiones pulmonares asociadas a cardiopatías complejas. De esa cifra global, 15 niños recibieron implantación protésica, de éstos 1 falleció para el 6,6%de este grupo, el 3,3%de los que necesitaron circulación extracorpórea y el 2,7%del total. A 6 pacientes se les practicó comisurotomía mitral cerrada con resultados satisfactorios inmediatos y a mediano plazo. El análisis de las complicaciones posoperatorias inmediatas fue adecuado y no se produjeron fenómenos negativos relacionados con la coagulación. La comparación con otras estadísticas internacionales revelan una panorámica favorable en la atención a este tipo de enfermo