Disección carotídea espontánea: Presentación de un caso clínico con revisión de la literatura / Carotid Artery Dissection. Case Report and Literature Review

Resumen Introducción: La disección carotídea consiste en el desgarro de la pared del vaso. Es una patología infrecuente, pero es la causa más común de enfermedad vascular cerebral (EVC) isquémica en personas menores de 45 años. Las manifestaciones clínicas son muy variables. Método: Utilizamos las recomendaciones CARE para el reporte de casos clínicos. Caso clínico: Hombre de 45 años previamente sano, con debilidad aguda de la extremidad torácica derecha sin causa aparente. La tomografía simple de cráneo no evidenció alteraciones. La resonancia magnética mostró una oclusión completa de la arteria carótida interna en todos sus segmentos y disminución del flujo de la arteria cerebral media izquierda. La evolución clínica fue desfavorable. Conclusión: La disección carotídea debe sospecharse en personas con EVC sin factores de riesgo cardiovascular.

Abstract Introduction: Carotid dissection consists of a tear in the vessel wall. It is a rare pathology, but it is the most common cause of ischemic cerebral vascular disease (CVD) in people under 45 years of age. The clinical manifestations are very variable. Method: We used CARE recommendations for reporting clinical cases. Clinical case: Previously, a healthy 45-year-old man with acute weakness of the right thoracic extremity without apparent cause. The simple skull tomography did not show any alterations. MRI showed complete occlusion of the internal carotid artery in all its segments and decreased flow of the left middle cerebral artery. The clinical evolution was unfavorable. Conclusion: Carotid dissection should be suspected in people with CVD without cardiovascular risk factors.

Estrategias lúdicas para mejorar la higiene bucal en una población con síndrome de Down / Playful strategies to improve oral health hygiene in a population with down síndrome / Estratégias lúdicas para melhorar a higiene bucal em um povoado com síndrome de Down

Resumen Objetivos: el objetivo de la investigación fue implementar estrategias lúdicas para mejorar la higiene oral de la población con Síndrome de Down en la Fundación CINDES de la ciudad de Pereira en el periodo 2017-2. Métodos: la investigación adoptó un enfoque cualitativo analizando el mundo social de acuerdo con su propia realidad y experiencia de las 12 personas diagnosticadas con SD y sus padres o cuidadores observándolos en su entorno natural y analizando sus habilidades previas acerca de las técnicas de higiene oral. El método de investigación fue la investigación acción y se usaron estrategias lúdicas, la observación y diarios de campo como técnicas de investigación. Resultados: se evidenció en la mayoría de la población con SD y sus padres o cuidadores que el nivel de conocimiento inicial era regular por el tiempo insuficiente durante el cepillado, falta de uso de la seda dental y mal comportamiento durante el cepillado; con la aplicación de estrategias lúdicas se logró que las personas con síndrome de Down aprendieran a identificar las estructuras de la cavidad oral, los implementos de higiene oral y los riesgos de no realizar un cuidado bucal adecuado, además, mejoraron la ejecución de la técnica de cepillado y se generó cierta autonomía. Conclusiones: se logró mostrar la efectividad de la implementación de estrategias lúdicas como herramienta crucial para lograr un aprendizaje significativo.

Abstract Objectives: The objective of this research was to implement playful strategies to improve the oral hygiene of the population with Down Syndrome (DS) in the CINDES Foundation in the city of Pereira during the 2017-2 period. Method: The research adopted a qualitative approach analyzing the social world according to the own reality and experience of 12 people diagnosed with DS and their parents or caregivers, observing them in their natural environment and analyzing their previous skills regarding oral hygiene techniques. The method applied was action research and playful strategies. Observation and field diaries were used as research techniques. Results: In the majority of the population with DS and their parents or caregivers, it was evidenced that their initial level of knowledge was mediocre due to insufficient time during brushing, lack of use of dental floss and bad behavior during brushing. With the application of playful strategies, it was possible for people with Down Syndrome to learn to identify the structures of the oral cavity, of oral hygiene implements and the risks of not performing adequate oral care. In addition, they improved the execution of the brushing technique and some autonomy was generated. Conclusions: It was possible to show the effectiveness of the implementation of playful strategies as an crucial tool to achieve meaningful learning.

Resumo Objetivos: o objetivo da pesquisa foi realizar estratégias lúdicas para melhorar a higiene oral num grupo com Síndrome de Down na Fundação CINDES da cidade de Pereira no período 2017-2. Métodos: a pesquisa adoptou um enfoque qualitativo analisando o mundo social de acordo com sua própria realidade e experiência das 12 pessoas diagnosticadas com SD e seus pais ou cuidadores observando-os em seu ambiente natural e analisando suas habilidades previas acerca das técnicas de higiene oral. O método de pesquisa foi a pesquisa ação e se usaram estratégias lúdicas, a observação e diários de campo como técnicas de pesquisa. Resultados: evidenciou-se na maioria deste grupo com SD e seus pais ou cuidadores que no nível de conhecimento inicial era regular pelo tempo insuficiente durante o escovado, falta de uso do fio dental e mal comportamento durante a escovação; com a aplicação de estratégias lúdicas se conseguiu que as pessoas com síndrome de Down aprenderam a identificar as estruturas da cavidade oral, o kit de higiene oral e os riscos de não realizar um cuidado bucal adequado, além disso melhora a execução da técnica de escovação e se gerou certa autonomia. Conclusões: conseguiu-se amostrar a efetividade da implementação de estratégias lúdicas como ferramenta crucial para lograr uma aprendizagem significativa.

Transcriptome Analysis of Pterygium and Pinguecula Reveals Evidence of Genomic Instability Associated with Chronic Inflammation.

Solar damage due to ultraviolet radiation (UVR) is implicated in the development of two proliferative lesions of the ocular surface: pterygium and pinguecula. Pterygium and pinguecula specimens were collected, along with adjacent healthy conjunctiva specimens. RNA was extracted and sequenced. Pairwise comparisons were made of differentially expressed genes (DEGs). Computational methods were used for analysis. Transcripts from 18,630 genes were identified. Comparison of two subgroups of pterygium specimens uncovered evidence of genomic instability associated with inflammation and the immune response; these changes were also observed in pinguecula, but to a lesser extent. Among the top DEGs were four genes encoding tumor suppressors that were downregulated in pterygium: C10orf90, RARRES1, DMBT1 and SCGB3A1; C10orf90 and RARRES1 were also downregulated in pinguecula. Ingenuity Pathway Analysis overwhelmingly linked DEGs to cancer for both lesions; however, both lesions are clearly still benign, as evidenced by the expression of other genes indicating their well-differentiated and non-invasive character. Pathways for epithelial cell proliferation were identified that distinguish the two lesions, as well as genes encoding specific pathway components. Upregulated DEGs common to both lesions, including KRT9 and TRPV3, provide a further insight into pathophysiology. Our findings suggest that pterygium and pinguecula, while benign lesions, are both on the pathological pathway towards neoplastic transformation.

Protein-Lipid Complex Separation Utilizing a Capillary Electrophoresis System.

The separation and analysis of protein-lipid complexes has proven to be challenging due to the harsh conditions required by conventional methods of protein or lipid isolation, which disrupt the fine forces that govern the interactions between lipid head groups and protein side chains. The method described in this publication presents an alternative for the separation of protein-lipid complexes while maintaining the integrity of their interactions. The method exploits the specific electrophoretic forces that are unique to the geometry of the capillary system and allows purification of intact complexes and the systematic analysis of its constituents. This technique is specifically applied for the separation of native protein-lipid complexes found in the central nervous system.

HSD18B7 Enzyme Assay Technique Using a Triple Quadrupole Mass Spectrometer.

Enzymes exist in all biological systems to catalyze vital biochemical reactions. The reactivity of an enzyme and the extent of its influence on product formation can give insight to understanding the physiological changes that can take place. The enzyme HSD17B7, involved in the cholesterol biosynthesis pathway, may play a role in influencing underlying changes during transition of disease, specifically in eyes at normal state to eyes that have glaucoma. In this work, we present a method to test the enzymatic activity level of HSD17B7 between normal and glaucomatous optic nerves to assess whether enzymatic upregulation of cholesterol biosynthesis may play a role in glaucoma.

Phospholipidomic Studies in Human Cornea From Climatic Droplet Keratopathy.

Climatic droplet keratopathy (CDK) is an acquired degenerative disease predominantly affecting males over 40 years old. It results in progressive corneal opacities usually affecting both eyes. CDK is multifactorial and its etiology remains unknown. Our recent findings are consistent with CDK pathology being driven by environmental factors with oxidative stress playing an important role (e.g.,, contributing to lipid peroxidation) rather than climate factors. The changes in corneal lipid composition affected by environmental factors remain understudied. The purpose of this study was to systematically investigate phospholipids profile (phosphatidylcholine [PC] and phosphatidylserine [PS]) in corneas from CDK patients using tandem mass spectrometry. Samples from CDK areas and from non-affected areas were obtained from patients diagnosed with CDK who underwent cataract surgery, were subjected to lipid extraction using a modified Bligh and Dyer method; protein concentrations were determined using the Bradford's method. Lipids were identified and subjected to ratiometric quantification using TSQ Quantum Access Max triple quadrupole mass spectrometer, using appropriate class specific lipid standards. All phospholipid classes showed lower total amounts in affected areas compared to control areas from CDK's corneas. Comparative profiles of two phospholipid classes (PC, PS) between CDK areas and control areas showed several common species between them. We also found a few unique lipids that were absent in CDK areas compared to controls and vice versa. Lower amount of phospholipids in CDK areas compared to control areas could be attributed to the lipid peroxidation in the affected corneal regions as a consequence of increased oxidative stress. J. Cell. Biochem. 118: 3920-3931, 2017. © 2017 Wiley Periodicals, Inc.

Climatic Droplet Keratopathy in Argentina: Involvement of Environmental Agents in Its Genesis Which Would Open the Prospect for New Therapeutic Interventions.

Climatic droplet keratopathy (CDK) is a degenerative corneal disease of unknown etiology. We described CDK for the first time in Latin America in the Argentinean Patagonia (El Cuy). A deeper knowledge of CDK pathogenic mechanisms will provide new therapeutic strategies. For that reason we investigated the prevalence of CDK in El Cuy and its existence in other 3 provinces with similar climate. Patients eyes were examined, habits throughout lives were inquired about, and serum ascorbate (sAA) was determined. All individuals work outdoors for most of the day. All regions had normal O3 levels. Individuals from regions 1, 2, and 3 had very low consumption of vegetables/fruits and low sAA levels. Conversely, region 4 individuals had balanced diet and higher sAA concentrations. CDK was only found in region 3 where individuals had partial deficiency of sAA and did not use eye protection. No CDK was found in regions 1 and 2 where individuals had similar work activities and dietary habits to those in region 3 but wear eye protection. No disease was found in region 4 where individuals work outdoors, have balanced diet, and use eye protection. To summarize, the CDK existence was related not only to climate but also to the dietary habits and lack of protection from sunlight.

Validación de la escala Schizophrenia Quality Of Life Scale (SQLS) para medir la calidad de vida en pacientes con diagnóstico de esquizofrenia en Colombia / Validation of the Schizophrenia Quality Of Life Scale (SQLS) to Measure Quality of Life in Patients Diagnosed With Schizophrenia in Colombia

Objetivo: Validar la escala SQLS para medir la calidad de vida de los pacientes con diagnóstico de esquizofrenia en Colombia. Métodos: Se aplicó a 251 pacientes la escala autoaplicable SQLS. La aplicación se repitió a los 2 días a 28 pacientes y a los 30 días a 38 pacientes para evaluar la confiabilidad test-retest y la sensibilidad al cambio respectivamente; 50 pacientes cumplimentaron además la escala SF-12 para determinar la validez concurrente. Resultados: Se encontraron tres dominios para la escala SQLS en Colombia: para los tres dominios se encontraron coeficientes alfa de Cronbach > 0,7. El modelo con tres factores no mostró un ajuste adecuado. En la evaluación test-retest, se encontraron valores de correlación adecuados (> 0,86). No se encontró una diferencia significativa en las mediciones de la sensibilidad al cambio. La validez concurrente mostró valores de correlación aceptables sólo con los dominios de la SF-12, relacionados con salud y funcionamiento mental. Conclusiones: Aunque la escala SQLS muestra una estructura factorial consistente con la propuesta original, buena consistencia interna y estabilidad en el tiempo, se requiere un estudio más detallado del funcionamiento de algunos ítems que pueden no estar midiendo el constructo adecuadamente.

Abstract Objective: To validate the SQLS scale in Colombian patients diagnosed with schizophrenia. Method: The self-report scale was applied to 251 patients. Measures of test-retest reliability, internal consistency and correlation inter-scales with the SF-12 were made by applying the scale 2 days later in 28 patients, and 30 days later in 38; 50 patients filled-out the SF-12 scale to determine the concurrent validity. Results: Three domains were found with all of them having Cronbach's alphas >0.7. The three factors model did not show adequate fit indexes.Test-retest evaluation showed satisfactory correlation values (>0.86). Sensitivity to change did not shown significant differences between the repeated measures. As regards concurrent validity, acceptable correlation values were found only in SF-12 domains related to mental health and functioning. Conclusions: The SQLS has a factorial structure consistent with previous reports, adequate internal consistency and temporal stability. However, a more detailed examination of some of these items is required, considering that the measurement of the construct does not appear to be adequate.

[Validation of the Schizophrenia Quality Of Life Scale (SQLS) to Measure Quality of Life in Patients Diagnosed With Schizophrenia in Colombia]. / Validación de la escala Schizophrenia Quality Of Life Scale (SQLS) para medir la calidad de vida en pacientes con diagnóstico de esquizofrenia en Colombia.

OBJECTIVE: To validate the SQLS scale in Colombian patients diagnosed with schizophrenia. METHOD: The self-report scale was applied to 251 patients. Measures of test-retest reliability, internal consistency and correlation inter-scales with the SF-12 were made by applying the scale 2 days later in 28 patients, and 30 days later in 38; 50 patients filled-out the SF-12 scale to determine the concurrent validity. RESULTS: Three domains were found with all of them having Cronbach's alphas >0.7. The three factors model did not show adequate fit indexes. Test-retest evaluation showed satisfactory correlation values (>0.86). Sensitivity to change did not shown significant differences between the repeated measures. As regards concurrent validity, acceptable correlation values were found only in SF-12 domains related to mental health and functioning. CONCLUSIONS: The SQLS has a factorial structure consistent with previous reports, adequate internal consistency and temporal stability. However, a more detailed examination of some of these items is required, considering that the measurement of the construct does not appear to be adequate.

Molecular modeling and site-directed mutagenesis reveal essential residues for catalysis in a prokaryote-type aspartate aminotransferase.

We recently reported that aspartate (Asp) biosynthesis in plant chloroplasts is catalyzed by two different Asp aminotransferases (AAT): a previously characterized eukaryote type and a prokaryote type (PT-AAT) similar to bacterial and archaebacterial enzymes. The available molecular and kinetic data suggest that the eukaryote-type AAT is involved in the shuttling of reducing equivalents through the plastidic membrane, whereas the PT-AAT could be involved in the biosynthesis of the Asp-derived amino acids inside the organelle. In this work, a comparative modeling of the PT-AAT enzyme from Pinus pinaster (PpAAT) was performed using x-ray structures of a bacterial AAT (Thermus thermophilus; Protein Data Bank accession nos. 1BJW and 1BKG) as templates. We computed a three-dimensional folding model of this plant homodimeric enzyme that has been used to investigate the functional importance of key amino acid residues in its active center. The overall structure of the model is similar to the one described for other AAT enzymes, from eukaryotic and prokaryotic sources, with two equivalent active sites each formed by residues of both subunits of the homodimer. Moreover, PpAAT monomers folded into one large and one small domain. However, PpAAT enzyme showed unique structural and functional characteristics that have been specifically described in the AATs from the prokaryotes Phormidium lapideum and T. thermophilus, such as those involved in the recognition of the substrate side chain or the "open-to-closed" transition following substrate binding. These predicted characteristics have been substantiated by site-direct mutagenesis analyses, and several critical residues (valine-206, serine-207, glutamine-346, glutamate-210, and phenylalanine-450) were identified and functionally characterized. The reported data represent a valuable resource to understand the function of this enzyme in plant amino acid metabolism.

The aspartate aminotransferase family in conifers: biochemical analysis of a prokaryotic-type enzyme from maritime pine.

Plant aspartate aminotransferase (AAT, EC 2.6.1.1) plays a key role in primary nitrogen assimilation, the transfer of reducing equivalents and the interchanges of carbon and nitrogen pools between subcellular compartments. We investigated the AAT family in conifers using maritime pine as the experimental model. Genes for cytosolic, mitochondrial and two plastidic isoenzymes (eukaryotic- and prokaryotic-types) were identified and their deduced amino acid sequences compared. The primary structure of the eukaryotic-type enzymes is quite well conserved, whereas the prokaryotic-type AAT is highly divergent (15% of identity). These molecular data were confirmed by the absence of immunological cross-reactivity between the two types of native AATs. The mature prokaryotic-type polypeptide was overexpressed in Escherichia coli, and the native enzyme was purified to apparent homogeneity and its molecular properties determined. The fully active recombinant holoenzyme showed highest catalytic activity at 50-60 degrees C and was moderately thermostable, retaining about 50% of its activity after incubation at 70 degrees C for 5-10 min. The presence of pyridoxal 5'-phosphate significantly increased the thermostability of the enzyme. These molecular characteristics were exploited to develop a rapid protocol for the purification of this prokaryotic-type enzyme from pine cotyledons. The results will be useful for studying aspartate and amino acid metabolism in trees.

Identification and functional analysis of a prokaryotic-type aspartate aminotransferase: implications for plant amino acid metabolism.

In this paper, we report the identification of genes from pine (PpAAT), Arabidopsis (AtAAT) and rice (OsAAT) encoding a novel class of aspartate aminotransferase (AAT, EC 2.6.1.1) in plants. The enzyme is unrelated to other eukaryotic AATs from plants and animals but similar to bacterial enzymes. Phylogenetic analysis indicates that this prokaryotic-type AAT is closely related to cyanobacterial enzymes, suggesting it might have an endosymbiotic origin. Interestingly, most of the essential residues involved in the interaction with the substrate and the attachment of pyridoxal phosphate cofactor in the active site of the enzyme were conserved in the deduced polypeptide. The polypeptide is processed in planta to a mature subunit of 45 kDa that is immunologically distinct from the cytosolic, mitochondrial and chloroplastic isoforms of AAT previously characterized in plants. Functional expression of PpAAT sequences in Escherichia coli showed that the processed precursor is assembled into a catalytically active homodimeric holoenzyme that is strictly specific for aspartate. These atypical genes are predominantly expressed in green tissues of pine, Arabidopsis and rice, suggesting a key role of this AAT in nitrogen metabolism associated with photosynthetic activity. Moreover, immunological analyses revealed that the plant prokaryotic-type AAT is a nuclear-encoded chloroplast protein. This implies that two plastidic AAT co-exist in plants: a eukaryotic type previously characterized and the prokaryotic type described here. The respective roles of these two enzymes in plant amino acid metabolism are discussed.

Expression patterns of two glutamine synthetase genes in zygotic and somatic pine embryos support specific roles in nitrogen metabolism during embryogenesis.

Here, embryo-specific patterns of glutamine synthetase (GS) genes were studied for the first time using pine somatic and zygotic embryogenesis as model systems. GS1a expression was absent in zygotic embryos whereas it was detected in the cotyledons of somatic embryos at late developmental stages along with transcripts for photosynthesis genes and arginase. These findings suggest that germination was initiated in maturing somatic embryos. GS1b transcripts were found mainly in procambial cells in both zygotic and somatic embryos. Expression of the GS1b in procambial cells before the differentiation of mature vascular elements indicated that this gene could be useful as a molecular marker for early stages of vascular differentiation in pine. Accordingly, a correlation was found between the quality of somatic embryos generated from three different cell lines and the pattern and level of GS1b expression. Our data suggest that GS1a and GS1b genes play distinct functional roles in the biosynthesis and mobilization of seed nitrogen reserves. Furthermore, the results presented may have potential application for improving conifer somatic embryogenesis.

Molecular aspects of nitrogen mobilization and recycling in trees.

Plants have developed a variety of molecular strategies to use limiting nutrients with a maximum efficiency. N assimilated into biomolecules can be released in the form of ammonium by plant metabolic activities in various physiological processes such as photorespiration, the biosynthesis of phenylpropanoids or the mobilization of stored reserves. Thus, efficient reassimilation mechanisms are required to reincorporate liberated ammonium into metabolism and maintain N plant economy. Although the biochemistry and molecular biology of ammonium recycling in annual herbaceous plants has been previously reported, the recent advances in woody plants need to be reviewed. Moreover, it is important to point out that N recycling is quantitatively massive during some of these metabolic processes in trees, including seed germination, the onset of dormancy and resumption of active growth or the biosynthesis of lignin that takes place during wood formation. Therefore, woody plants constitute an excellent system as a model to study N mobilization and recycling. The aim of this paper is to provide an overview of different physiological processes in woody perennials that challenge the overall plant N economy by releasing important amounts of inorganic N in the form of ammonium.

Molecular and enzymatic analysis of ammonium assimilation in woody plants.

Ammonium is assimilated into amino acids through the sequential action of glutamine synthetase (GS) and glutamate synthase (GOGAT) enzymes. This metabolic pathway is driven by energy, reducing power and requires the net supply of 2-oxoglutarate that can be provided by the reaction catalysed by isocitrate dehydrogenase (IDH). Most studies on the biochemistry and molecular biology of N-assimilating enzymes have been carried out on annual plant species and the available information on woody models is far more limited. This is in spite of their economic and ecological importance and the fact that nitrogen is a common limiting factor for tree growth. GS, GOGAT and IDH enzymes have been purified from several woody species and their kinetic and molecular properties determined. A number of cDNA clones have also been isolated and characterized. Although the enzymes are remarkably well conserved along the evolutionary scale, major differences have been found in their compartmentation within the cell between angiosperms and conifers, suggesting possible adaptations to specific functional roles. The analysis of the gene expression patterns in a variety of biological situations such as changes in N nutrition, development, biotic or abiotic stresses and senescence, suggest that cytosolic GS plays a central and pivotal role in ammonium assimilation and metabolism in woody plants. The modification of N assimilation efficiency has been recently approached in trees by overexpression of a cytosolic pine GS in poplar. The results obtained, suggest that an increase in cytosolic GS might lead to a global effect on the synthesis of nitrogenous compounds in the leaves, with enhanced vegetative growth of transgenic trees. All these data suggest that manipulation of cytosolic GS may have consequences for plant growth and biomass production.

The promoter of a cytosolic glutamine synthetase gene from the conifer Pinus sylvestris is active in cotyledons of germinating seeds and light-regulated in transgenic Arabidopsis thaliana.

We have isolated and characterized a genomic clone encoding Scots pine (Pinus sylvestris) cytosolic glutamine synthetase (GS). The clone contains the 5' end half of the gene including part of the coding region and 980 bp upstream of the translation initiation codon. The major transcription start site (+1) was mapped around 180 nucleotides upstream of the translation initiation codon. Sequence analysis of the 5'-upstream region of the gene reveals the presence of putative regulatory elements including a poly-CT consensus sequence, a purine-rich tandem repeat and two AT-rich regions. Fusions of the upstream gene region to uidA were shown to be transiently expressed in the cotyledons of germinating pine seeds transformed by microprojectile bombardment. Stable transformation of Arabidopsis thaliana revealed the shoot apical meristem as the major region of heterologous permanent expression in Arabidopsis, in agreement with the expression of the GS gene in Pinus. Moreover, quantitative data derived from fluorometric beta-glucuronidase assays in control and continuous light-grown transgenic Arabidopsis plants indicate that the isolated upstream region of the gene contains regulatory sequences involved in the response to light.

Maltrato infantil en Colombia / Infantile maltreatment in Colombia

El maltrato infantil a despertado en Colombia hace algunos anos, no es que nunca antes hubiera existido, pero si había estado oculto debido a una cultura violenta, al temor, la sumisión e indefensión de los niños frente a "sus mayores", quienes son sus principales agresores. El súbito despertar de este monstruo del maltrato se ha debido ha un cambio en la mentalidad que ha sido acompañado por la liberación femenina y que ha puesto al descubierto toda la tragedia a la que había estado expuesta la familia gracias a la cultura violenta y represiva de nuestro país. En efecto, la perdida de ese miedo, la concientización y el apoyo recién brindado por el gobierno através de sus nuevas instituciones y leyes de ayuda al menor, han dejado ver los abusos y maltratos de que es víctima este sector de la población. Ante las apabuyantes cifras recogidas se han tomado medidas serias frente al asunto del maltrato infantil creando programas de educación para la prevención de este mal, así como dando una voz de alerta para despertar a la ciudadanía a que colabore en la erradicación del monstruo del maltrato. Sinembargo esto es sólo el comienzo todavía queda mucho camino por recorrer. Es por esto que este documento el informar acerca del mal para que deje de sernos ajeno y pongamos empeño en buscar soluciones...