Mostrar el registro sencillo del documento

Relación entre el polimorfismo ANK3 (rs10994336) y el desempeño en pruebas neuropsicológicas en pacientes con trastorno afectivo bipolar. Una submuestra colombiana

dc.rights.licenseAtribución-NoComercial 4.0 Internacional
dc.contributor.advisorArboleda Granados, Humberto
dc.contributor.advisorVásquez Rojas, Rafael Antonio
dc.contributor.authorRomero Ibagón, Ana María
dc.date.accessioned2020-07-20T17:26:17Z
dc.date.available2020-07-20T17:26:17Z
dc.date.issued2020-04-24
dc.identifier.urihttps://repositorio.unal.edu.co/handle/unal/77802
dc.description.abstractEl Trastorno Afectivo Bipolar (TAB) es una enfermedad neuropsiquiátrica que genera una serie de afectaciones cognitivas que pueden estar relacionadas a variantes genéticas poco estudiadas en la población bogotana. Debido a esto, el objetivo de este estudio fue analizar la relación entre SNP del gen ANK3 (rs10994336) y el TAB en una sub muestra de pacientes residentes en Bogotá. Para esto, se realizó un estudio descriptivo- comparativo de corte transversal en una población de 27 sujetos con TAB y 25 sujetos control pareados por edad, sexo y escolaridad. A todos los participantes se les realizó una completa valoración por neuropsicología, la construcción de un genograma con los antecedentes médicos en tres líneas generacionales y una toma de muestra de sangre para el análisis genético. Se observó que los pacientes con TAB tienen un desempeño significativamente menor a los sujetos control en tareas que miden la velocidad de procesamiento y la memoria anterógrada. Se encontró que los sujetos con TAB tienen un mayor número de antecedentes de enfermedades psiquiátricas en las tres generaciones familiares en relación a los sujetos control. No se encontró ninguna asociación del SNP estudiado con de las variables clínicas y familiares estudiadas. Se concluye que el perfil cognitivo del TAB en periodos de eutimia involucra una afectación en procesos ejecutivos y amnésicos. Sin embargo, esta afectación no se relación con el SNP estudiado, aunque siguen existiendo un componente genético que se puede observar por medio de los antecedentes de enfermedades psiquiátricas en las familias de los pacientes.
dc.description.abstractBipolar Affective Disorder (TAB) is a neuropsychiatric disease that generates a series of cognitive disorders that may be related to genetic variants little studied in the Bogota population. Due to this, the objective of this study was to analyze the relationship between SNP of the ANK3 gene (rs10994336) and the TAB in a sub-sample of patients residing in Bogotá. For this, a descriptive-comparative cross-sectional study was carried out in a population of 27 subjects with TAB and 25 control subjects matched by age, sex and education. All participants underwent a complete evaluation by neuropsychology, the genogram construction with the medical history of three generational lines and a blood sample for genetic analysis. Was found that patients with TAB have significantly lower performance than control subjects in tasks that measure speed process and long term memory. The subjects with TAB were found to have a greater number of medical history of psychiatric illnesses in the three family generations in relation to control subjects. No association of the SNP studied with the clinical and family variables studied was found. It is concluded that the cognitive profile of TAB in periods of euthymia involves an affectation in executive and amnesic processes. However, this affectation is not related to the SNP studied, although there is still a genetic component that can be observed through the history of psychiatric diseases in patient’s families.
dc.format.extent169
dc.format.mimetypeapplication/pdf
dc.language.isospa
dc.rightsDerechos reservados - Universidad Nacional de Colombia
dc.rights.urihttp://creativecommons.org/licenses/by-nc/4.0/
dc.titleRelación entre el polimorfismo ANK3 (rs10994336) y el desempeño en pruebas neuropsicológicas en pacientes con trastorno afectivo bipolar. Una submuestra colombiana
dc.typeOtro
dc.rights.spaAcceso abierto
dc.description.additionalLínea de Investigación: Neurociencias
dc.type.driverinfo:eu-repo/semantics/other
dc.type.versioninfo:eu-repo/semantics/acceptedVersion
dc.publisher.programBogotá - Medicina - Maestría en Neurociencias
dc.description.degreelevelMaestría
dc.publisher.branchUniversidad Nacional de Colombia - Sede Bogotá
dc.relation.referencesEncuesta Nacional de Salud Mental. (2015). Ministerio de Salud. Colciencias
dc.relation.referencesGildengers AG, Mulsant BH, Al Jurdi RK, Beyer JL, Greenberg RL, Gyulai L, et al. (2010). The relationship of bipolar disorder lifetime duration and vascular burden to cognition in older adults. Bipolar Disord, 12(8), 851–8
dc.relation.referencesAltshuler LL, Bearden CE, Green MF, van Gorp W, Mintz J. (2008) A relationship between neurocognitive impairment and functional impairment in bipolar disorder: A pilot study, Psychiatry Res, 15(1–3), 289–93
dc.relation.referencesBoland EM, Alloy LB. (2013) Sleep disturbance and cognitive deficits in bipolar disorder: Toward an integrated examination of disorder maintenance and functional impairment, Clin Psychol Rev, 33(1), 33–44.
dc.relation.referencesBraw Y, Erez G, Sela T, Gvirts HZ, Hare EV, Bloch Y, et al. (2013). A longitudinal study of cognition in asymptomatic and mildly symptomatic bipolar disorder patients. Psychiatry Res, 210(3), 842–9.
dc.relation.referencesYoung RC, Murphy CF, Heo M, Schulberg HC, Alexopoulos GS. (2006). Cognitive impairment in bipolar disorder in old age: Literature review and findings in manic patients. Paula Clayton Festschr, 92(1),125–31.
dc.relation.referencesRobinson LJ, Thompson JM, Gallagher P, Goswami U, Young AH, Ferrier IN, et al. (2006). A meta-analysis of cognitive deficits in euthymic patients with bipolar disorder. J Affect Disord. 93(1–3),105–15.
dc.relation.referencesBaez S, Ibanez A, Gleichgerrcht E, Perez A, Roca M, Manes F, et al. (2014). The utility of IFS (INECO Frontal Screening) for the detection of executive dysfunction in adults with bipolar disorder and ADHD. Psychiatry Res, 15;216(2), 269–76.
dc.relation.referencesPompei F, Dima D, Rubia K, Kumari V, Frangou S. (2011). Dissociable functional connectivity changes during the Stroop task relating to risk, resilience and disease expression in bipolar disorder. NeuroImage. 15;57(2), 576–82.
dc.relation.referencesGarcía-Blanco AC, Perea M, Salmerón L. (2013). Attention orienting and inhibitory control across the different mood states in bipolar disorder: An emotional antisaccade task. Biol Psychol, 94(3), 556–61.
dc.relation.referencesCorona R, Berlanga C, Gutierrez-Mora D, Fresán, A. (2007). La detección de casos de trastorno bipolar por medio de un instrumento de tamizaje: El cuestionario de trastornos del ánimo versión en español. Salud Mental. 30(2), 50-57.
dc.relation.referencesCañas F, Roca M. Adherencia terapéutica en la esquizofrenia y otros trastornos psiquiátricos. (2007). Editorial Ars Medica. Barcelona. España. Capítulo 2.2 Trastornos bipolares.
dc.relation.referencesBo Q, Mao Z, Xianbin L, Wang Z, Wang C, Ma X. (2017). Use of the MATRICS consensus cognitive battery (MCCB) to evaluate cognitive deficits in bipolar disorder: A systematic review and meta-analysis. PLoS ONE, 12(4), e0176212. https://doi.org/10.1371/journal.pone.0176212
dc.relation.referencesDurand V, Barlow D. Psicopatología. Un enfoque integral de la psicología anormal. Editorial Cengage Learning Editores S.A. Mexico D.F. pag. 228.
dc.relation.referencesPereira, L; Köhlera, C; de Sousab, R; Solmic, M; de Freitasa, B; Fornaroe, M; Veirab, R; Miskowiakf, K; Vietag, E; Veronesed, N; Stubbsd, B & Carvalhoa, A. (2017). The relationship between genetic risk variants with brain structure and function in bipolar disorder: A systematic review of genetic- neuroimaging studies. Neuroscience and Biobehavioral Reviews. 79, 87-109.
dc.relation.referencesRogelio L, Berrios G. (2011).Historia de los trastornos afectivos.Revista colombiana de psiquiatría. 40(5), 130–146.
dc.relation.referencesBerutti M, Nery F, Sato R, Scippa A, Kapczinski F & Lafer B. (2014). Association between family history of mood disorders and clinical characteristics of bipolar disorder: Results from the Brazilian bipolar research network. Journal of Affective Disorders. 161, 104–108.
dc.relation.referencesGella A, Segura M, Durany N, Pfuhlmann B, Stöber G & Gawlik M. (2011). Is Ankyrin a genetic risk factor for psychiatric phenotypes?. BMC Psychiatry. 11(103), 1-5.
dc.relation.referencesOta M, Hori H, Sato N, Yoshida F, Hattori K, Teraishi T & Kunugi H. (2016). Effects of ankyrin 3 gene risk variants on brain structures in patients with bipolar disorder and healthy subjects. Psychiatry and Clinical Neurosciences. 70, 498–506.
dc.relation.referencesRueckert E, Barker D, Ruderfer D, Bergen S, O’Dushlaine C, Luce C, Sheridan S, Theriault K, Chambert K, Moran J, Purcell S, Madison J, Haggarty S and Sklar P. (2013). Cis-acting regulation of brain-specific ANK3 gene expression by a genetic variant associated with bipolar disorder. Molecular Psychiatry. 18, 922–929.
dc.relation.referencesEuropean Bioinformatics Institute. (n.d). Retrived from https://www.ebi.ac.uk/gwas/variants/rs10994336
dc.relation.referencesCassidy C, Buchy L, Bodnar M, Dell’Elce J, Choudhry Z, Fathalli F, Sengupta S, Fox R, Malla A, Lepage M, Iyer S and Joober R. (2014). Association of a risk allele of ANK3 with cognitive performance and cortical thickness in patients with firstepisode psychosis. J Psychiatry Neurosci.39(1), 31-39.
dc.relation.referencesZhao W, Zhang Q, Yu P, Zhang Z, Chen X, Gu H, Zhai J, Chen M, Du B, Deng X, Ji F, Wang C, Xiang Y, Li D, Wu H, Dong Q, Luo Y, Li J, and Chen C. (2016). The ANK3 Gene and Facial Affect Processing: An ERP Study. Am J Med Genet Part B 171B, 861–866.
dc.relation.referencesRoby Y. (2017). ANK3 gene polymorphisms and bipolar disorder: a meta-analysis. Psychiatric Genetics, 27, 225–235.
dc.relation.referencesDelvecchio G, Dima D and Frangou S. (2015). The Effect of ANK3 Bipolar-Risk Polymorphisms on the Working Memory Circuitry Differs Between Loci and According to Risk-Status for Bipolar Disorder.Am J Med Genet Part B 168B,188– 196.
dc.relation.referencesAsociación Americana de Psiquiatría. (2014). Manual diagnóstico y estadístico de los trastornos mentales DSM-5. España: Editorial Médica Panamericana.
dc.relation.referencesBaune B and Malhi G. (2015). A review on the impact of cognitive dysfunction on social, occupational, and general functional outcomes in bipolar disorder. Bipolar Disorders, 17, 41–55.
dc.relation.referencesKonstantakopoulos G, loannidi N, Typaldou M, Sakkas D and Oulis P. (2016). Clinical and cognitive factors affecting psychosocial functioning in remitted patients with bipolar disorder. Psychiatriki, 27,182-191.
dc.relation.referencesCrandall E, Ruggero C, Bain K and Kilmer J. (2014). Adjustment difficulties and caregiving burdens faced by college students with a parent with bipolar or depressive disorders. Journal of College Student Psychotherapy. 28, 47-58.
dc.relation.referencesMonsalve M, Hincapie J, Salazar A y Amariles P. (2015). Identificación y caracterización de los costos relacionados con la atención al paciente con trastorno afectivo bipolar i que recibe seguimiento farmacoterapéutico. Vitae 22, 114-118.
dc.relation.referencesPompili M, Gonda X, Serafini G, Innamorati M, Sher L, Amore M, Rihmer Z, Girardi P. (2013). Epidemiology of suicide in bipolar disorders: a systematic review of the literature. Bipolar Disord 15, 457–490.
dc.relation.referencesJolin E, Eller E and Weller R. (2007). The Public Health Aspects of Bipolar Disorder in Children and Adolescents. Current Psychiatry Reports. 9, 106– 113.
dc.relation.referencesConus P, Macneil C, McGorry PD. (2014). Public health significance of bipolar disorder: implications for early intervention and prevention. Bipolar Disord 16, 548– 556.
dc.relation.referencesRojo E y Tabarés R. (2006). Manual práctico de cognición en la esquizofrenia y el trastorno bipolar. Editorial Ars Médica. Barcelona. España. Capitulo 3. Funciones cognitivas alteradas y preservadas en el trastorno bipolar.
dc.relation.referencesCastañeda M y Tirado E. (2008). Deficiencias mnésicas, ejecutivas y atencionales como endofenotipos neurocognitivos en el trastorno bipolar: una revisión. Salud Mental. 31, 145-150.
dc.relation.referencesSchouws S, Comijs H, Dols A, Beekman A and Stek M. (2016). Five-year follow-up of cognitive impairment in older adults with bipolar disorder. Bipolar Disord. 18,148– 154.
dc.relation.referencesRodriguez, R., Fernandez, H., Bagney, A., Dompablo, M., Torio, I., Rodríguez, C y Rodríguez, J. (2013). Cognición y Esquizofrenia: De la Neurocognición a la Cognición Social. Revista do Serviço de Psiquiatria do Hospital Prof. Doutor Fernando Fonseca, 11(1), 10-24.
dc.relation.referencesVaroa C, Jimeneza E, Soléa B, Bonnína C, Torrenta C, Vallsa E, Morillaa I, Laherab G, Martínez-Arána A, Vietaa E and Reinaresa M. (2017). Social cognition in bipolar disorder: Focus on emotional intelligence. Journal of Affective Disorders. 217, 210- 217.
dc.relation.referencesBora E and Pantelis C. (2016). Social cognition in schizophrenia in comparison to bipolar disorder: A meta-analysis. Schizophrenia Research. 175, 72-78.
dc.relation.referencesBora R and Özerdem A. (2017). Social cognition in first-degree relatives of patients with bipolar disorder: A meta-analysis. European Neuropsychopharmacology 27, 293–300.
dc.relation.referencesStrakowski S, Del Bello M and Adler C. 2005. The functional neuroanatomy of bipolar disorder: a review of neuroimaging findings. Molecular Psychiatry. 10, 105– 116.
dc.relation.referencesKato T. (2017). Neurobiological basis of bipolar disorder: Mitochondrial dysfunction hypothesis and beyond. Schizophrenia Research. 187, 62–66.
dc.relation.referencesSerretti A, Chiesa A, Calati R, Linotte S, Sentissi O, Papageorgiou K, Kasper S, Zohar J, De Ronchi D, Mendlewicz J, Amital D, Montgomery S and Souery D. (2013). Influence of family history of major depression, bipolar disorder, and suicide on clinical features in patients with major depression and bipolar disorder. Eur Arch Psychiatry Clin Neurosci. 263, 93–103.
dc.relation.referencesPalacio J, Zapata A, Aguirre D, Estrada S, Tamayo A, Lopera J, López M y López C. (2011). Hijos de pacientes con trastorno afectivo bipolar tipo I de una población paisa: perfil psicopatológico y neuropsicológico. Revista Colombiana de Psiquiatría. 40, 90-107.
dc.relation.referencesÖzdemir O, Coşkun S, Aktan E, Özdemir P, Atli A, Yilmaz E and Keskin S. (2016). Family History in Patients with Bipolar Disorder. Arch Neuropsychiatry. 53, 276-279.
dc.relation.referencesAmerican Psychiatric Association. (2013). Highlights of Changes from DSM-IV-TR to DSM-5. Extraido de: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM_ Changes_from_DSM-IV-TR_-to_DSM-5.pdf el 28 de Marzo de 2018.
dc.relation.referencesMasouy A, Chopard G, Vandel P, Magnin E, Rumbach L, Sechter D, et al. (2011). Bipolar disorder and dementia: where is the link? Psychogeriatrics. 11(1), 60–7.
dc.relation.referencesVolkert J, Schiele M, Kazmaier J, Glaser F, Zierhut K, Kopf J, Kittel-Schneider S and Reif A. (2016). Cognitive deficits in bipolar disorder: from acute episode to remission. Eur Arch Psychiatry Clin Neurosci. 266,225–237.
dc.relation.referencesSchouwsa S, Comijsa H, Dols A, Beekmanb A, and Stek M. (2016). Five-year followup of cognitive impairment in older adults with bipolar disorder. Bipolar Disorders. 18, 148–154.
dc.relation.referencesNasreddine, Z., Phillips, N., Be´dirian, V., Charbonneau, S., Whitehead, V., Collin, I., … Chertkow, H. (2005). The Montreal Cognitive Assessment , MoCA : A Brief Screening. American Get, 695–699. http://doi.org/10.1111/j.1532- 5415.2005.53221.x
dc.relation.referencesPedraza, O., Sánchez, E., Plata, S. J., Montalvo, C., Galvis, P., Chiquillo, A., & Arévalo-rodríguez, I. (2014). Puntuaciones del MoCA y el MMSE en pacientes con deterioro cognitivo leve y demencia en una clínica de memoria en Bogotá. Acta Neurologica Colombiana, 30(1), 22–31.
dc.relation.referencesTorralva, T., Roca, M., Gleichgerrcht, E., López, P., & Manes, F. (2009). INECO Frontal Screening (IFS): a brief, sensitive, and specific tool to assess executive functions in dementia. Journal of the International Neuropsychological Society: JINS, 15(5), 777–786. http://doi.org/10.1017/S1355617710000883
dc.relation.referencesRomero-Vanegas, S., Vargas-Gonzalez, J., Arboleda, H., Lopera, F., & Pardo, R. (2014). Validation of the Ineco Frontal Screening in a Colombian Population. Alzheimer’s & Dementia, 10(4). http://doi.org/10.1016/j.jalz.2014.05.1348
dc.relation.referencesHamilton, M. (1960). A rating scale for depression. J Neurol Neurosurg Psychiatry, 23(1), 56–62.
dc.relation.referencesRamos, B & Cordero, V. (1988). A new validation of the Hamilton Rating Scale for Depression. J Psychiatr Res, 22(1), 21-8.
dc.relation.referencesYoung, R.C., Biggs, J.T., Ziegler, V.E. and Meyer, D.A. (1978) A rating scale for mania: Reliability, validity and sensitivity. British Journal of Psychiatry, 133, 429- 435. http://dx.doi.org/10.1192/bjp.133.5.429
dc.relation.referencesColom F, Vieta E, Martinez-Arán A, García-García M, Reinares M, Torrent C, Goikolea JM, Banús S, Salamero M. (2002). Versión española de una escala de evaluación de la manía: validez y fiabilidad de la Escala de Young. Medicina Clínica, 119(10), 366-371.
dc.relation.referencesDelis, D. C., Kramer, J. H., Kaplan, E., & Ober, B. A. (1987). CVLT, California Verbal Learning Test: Adult Version: Manual. Psychological Corporation.
dc.relation.referencesPeña-Casanova, J., Gramunt-Fombuena, N., Quiñones-Úbeda, S., Sánchez- Benavides, G., Aguilar, M., Badenes, D., … Blesa, R. (2009). Spanish multicenter normative studies (NEURONORMA project): Norms for the rey-osterrieth complex figure (copy and memory), and free and cued selective reminding test. Archives of Clinical Neuropsychology, 24(4), 371–393. http://doi.org/10.1093/arclin/acp041
dc.relation.referencesStrauss, E., Sherman, E., & Spreen, O. (2006). A compendium of neuropsychological tests administration, norms, and commentary. Retrieved from https://books.google.com/books?hl=en&lr=&id=jQ7n4QVw70C&oi=fnd&pg=PR16& dq=A+compendium+of+neuropsychological+tests:+Administration,+norms&ots=F6 4XRFNs05&sig=_X-qIUrBz94PfMeiN1UW7ZB6AMM.
dc.relation.referencesPartington, J. E., & Leiter, R. G. (1949). Partington’s Pathways Test. Psychological Service Center Journal.
dc.relation.referencesWechsler, D. (1981). WAIS-R Manual: Wechsler Adult Intelligence Scale-Revised. San Antonio, TX: The Psychological Corporation.
dc.relation.referencesReynolds, C. R. (1997). Forward and backward memory span should not be combined for clinical analysis. Archives of Clinical Neuropsychology, 12(1), 29–40. http://doi.org/10.1016/S0887-6177(96)00015-7
dc.relation.referencesKaplan, E., Fein, D., Morris, R. G., & Delis, D. C. (1991). The Wechsler Adult Intelligence Scale—Revised as a Neuropsychological Instrument Manual. Psychological Corporation.
dc.relation.referencesJensen, A. R. (1966). The stroop color-word test: a review. Acta Psychologica, I, 36–93.
dc.relation.referencesCulbertson, W., Moberg, P., Duda, J., Stern, M., & Weintraub, D. (2004). Assessing the executive function deficits of patients with Parkinson’s disease: Utility of the Tower of London-Drexel. Assessment, 11(1), 27–39. http://doi.org/10.1177/1073191103258590
dc.relation.referencesNelson, H. E. (1976). A modified card sorting test sensitive to frontal lobe defects. Cortex, 12(4), 313–324.
dc.relation.referencesBaron-Cohen, S., O’Riordan, M., Jones, R., Stone, V. E., and Plaisted, K. (1999). A new test of social sensitivity: detection of faux pas in normal children and children with Asperger syndrome. J. Autism Dev. Disord. 29, 407–418.
dc.relation.referencesMcDonald, S., Flanagan, S., Rollins, J., and Kinch, J. (2003). TASIT: a new clinical tool for assessing social perception after traumatic brain injury. J. Head Trauma Rehabil. 18, 219–238.
dc.relation.referencesGronwall, D. (1977). Paced auditory serial-addition task: A measure of recovery from concussion. Perceptual motor skills. 44, 367-373.
dc.relation.referencesLlorca, J., Prieto, D., Combarros, O., Dierssen, T & Berciano, J. (2005). Riesgos competitivos de muerte y equilibrio de Hardy-Weinberg en estudios de casos y controles sobre asociación entre genes y enfermedades. Gac Sanit. 19(4), 321-4.
dc.relation.referencesChhitij, S., Anupam, B., Mukul, S & Sanjay, K. (2019). Cognitive Deficits in Euthymic Patients With Bipolar Disorder. The Journal of Nervous and Mental Disease. 207(2). 100-105.
dc.relation.referencesNguyen, T. T., Kovacevic, S., Dev, S. I., Lu, K., Liu, T. T., & Eyler, L. T. (2016). Dynamic Functional Connectivity in Bipolar Disorder Is Associated With Executive Function and Processing Speed: A Preliminary Study. Neuropsychology. Advance online publication. http:// dx.doi.org/10.1037/neu0000317.
dc.relation.referencesGau, C., Chang, C., Tsai, F., Chao, P & Gau, S. (2010). Association between mood stabilizers and hypothyroidism in patients with bipolar disorders: a nested, matched case-control study. Bipolar Disord. (12). 253–263.
dc.relation.referencesLambert, G., Mazurie, A., Lauve, N., Hurwitz N., Young, S., Obenchain, R., Hengartner, N., Perkins, D., Tohen, M & Kerner, B. (2016). Hypothyroidism risk compared among nine common bipolar disorder therapies in a large US cohort. Bipolar Disord. (18) 247–260.
dc.rights.accessrightsinfo:eu-repo/semantics/openAccess
dc.subject.proposaltrastorno afectivo bipolar
dc.subject.proposalBipolar affective disorder
dc.subject.proposalcognición
dc.subject.proposalCognition
dc.subject.proposalneuropsicología
dc.subject.proposalNeuropsychology
dc.subject.proposalpolimorfismo
dc.subject.proposalPolymorphism
dc.subject.proposalANK3 gene
dc.subject.proposalgen ANK3
dc.type.coarhttp://purl.org/coar/resource_type/c_1843
dc.type.coarversionhttp://purl.org/coar/version/c_ab4af688f83e57aa
dc.type.contentText
oaire.accessrightshttp://purl.org/coar/access_right/c_abf2


Archivos en el documento

Thumbnail
Nombre:
1016042072.2020.pdf
Tamaño:
2.583Mb
Formato:
PDF
Descargar
Thumbnail
Nombre:
license_rdf
Tamaño:
701bytes
Formato:
application/rdf+xml
Descargar

Este documento aparece en la(s) siguiente(s) colección(ones)

Mostrar el registro sencillo del documento

Atribución-NoComercial 4.0 InternacionalEsta obra está bajo licencia internacional Creative Commons Reconocimiento-NoComercial 4.0.Este documento ha sido depositado por parte de el(los) autor(es) bajo la siguiente constancia de depósito