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ANTECEDENTES 3H KLÄJPLUJPH ZLSLJ[P]H KL 0N( LZ SH PUT\UVKLÄJPLUJPH JVU TH`VY WYL]HSLUJPH LU [VKV LS T\UKVJVUTHUPMLZ[HJP}UJSxUPJHHTWSPHX\L ]HYxHKLSHZMVYTHZHZPU[VTm[PJHZPKLU[PÄJHKHZ JVTVOHSSHaNVKLSHIVYH[VYPVLULSTHYJVKL\U estudio clínico por causas no relacionadas con la PUT\UVKLÄJPLUJPHOHZ[HMVYTHZTmZSSHTH[P]HZ X\LJ\YZHUJVUPUMLJJPVULZKLYLWL[PJP}ULUSHZ T\JVZHZ`X\LOHIP[\HSTLU[LZVU!ZPU\ZP[PZV[P[PZ LPUMLJJPVULZKLSHZ]xHZYLZWPYH[VYPHZ`KPNLZ[P]HZ1 con sólo algunos pacientes con progresión HPUT\UVKLÄJPLUJPHJVTU]HYPHISL2 CASO CLÍNICO 7HJPLU[LMLTLUPUHKLH|VZKLLKHKKLYHaH JH\JmZPJHUHJPKHLU,ZWH|HX\LZLLU]P}HSH JVUZ\S[H KL 0UT\UVSVNxH S\LNV KL L]HS\HYSH LULSZLY]PJPVKL5L\TVSVNxHWVYWHKLJLY[VZ JY}UPJH ` WYVK\J[P]H JVU LZW\[VZ W\Y\SLU[VZ KPHYPVZKL[LJJP}UKLKLÄJPLUJPHZLSLJ[P]HKL0N( LU Z\LYV ` IYVUX\PLJ[HZPHZ IHZHSLZ IPSH[LYHSLZ por tomografía computada de alta resolución. 3H WHJPLU[L UV YLÄYP} HU[LJLKLU[LZ MHTPSPHYLZ KL PUT\UVKLÄJPLUJPH UP JVUZHUN\PUPKHK JVU HU[LJLKLU[LZWLYZVUHSLZX\LUVTVZ[YHIHUKH[VZ KLPU[LYtZJSxUPJVOHZ[HSVZ[YLZH|VZKLLKHK J\HUKV WHKLJP} \U J\HKYV KL UL\TVUxH :L ]HJ\U}KLHJ\LYKVJVULSJHSLUKHYPVKL]HJ\UHZ OHIP[\HS LU ,ZWH|H WHYH Z\ LKHK X\L PUJS\`} SHZ]HJ\UHZJVU[YHLS]PY\ZKLSHOLWH[P[PZ)`LS [V_VPKL[L[mUPJV *\HUKV SSLN} H U\LZ[YH JVUZ\S[H YLÄYP} X\L KLZKLOHJxHJ\H[YVH|VZWHKLJxH\UHTLKPHKL ZLPZWYVJLZVZPUMLJJPVZVZKLSHZ]xHZYLZWPYH[Vrias bajas, distribuidos a lo largo del año, sin HSP]PV K\YHU[L SVZ TLZLZ KL ]LYHUV 3H TH`VY parte de estos procesos se diagnosticaron como IYVUX\P[PZ`YLX\PYPLYVUSHHKTPUPZ[YHJP}UKLHUtibióticos. El curso tórpido de la paciente, junto JVUSHL]VS\JP}UKLIYVUX\PLJ[HZPHZIPSH[LYHSLZ X\LLUU\LZ[YHL_WLYPLUJPHLZ\UOHSSHaNVWVJV WYL]HSLU[LLUWHJPLU[LZJVUKLÄJPLUJPHZLSLJ[P]H KL0N(+:0N(`TmZMYLJ\LU[LTLU[LLUJVU[YHKV LU SH PUT\UVKLÄJPLUJPH JVTU ]HYPHISL UVZ OPaV ZVZWLJOHY \U [YHZ[VYUV TmZ ZL]LYV KL SH PUT\UPKHKO\TVYHSWVYSVX\LYLHSPaHTVZLZ[\KPVZWHYH]HSVYHYSHJHWHJPKHKKLWYVK\JJP}U KLHU[PJ\LYWVZLZWLJxÄJVZ (SZHILYX\LHSHWHJPLU[LSH]HJ\UHYVUHU[LYPVYTLU[LJVU[YHLS[V_VPKL[L[mUPJVJVTVWHY[LKL Z\JHSLUKHYPVKL]HJ\UHJP}UPUMHU[PS`JVU[YHLS UL\TVJVJV OHJxH [YLZ H|VZ J\HUKV ZL ]HSVY} LU LS ZLY]PJPV KL 5L\TVSVNxH KLJPKPTVZ L_[YHLYT\LZ[YHZKLZ\LYVWHYHHUHSPaHYSVZ]HSVYLZ 319 Revista Alergia México IHZHSLZ KL HU[PJ\LYWVZ LZWLJxÄJVZ WHYH LZ[VZ WH[}NLUVZ ` ]HJ\UHYSH KL U\L]V JVU +PM[H]H_ :HUVÄ7HZ[L\Y4:+-YHUJPHX\LLZ\UH]HJ\UH WYV[LPJHJVU[YHLS[V_VPKL[L[mUPJV`JVU7UL\TV:HUVÄ7HZ[L\Y4:+-YHUJPH]HJ\UHKL ZLYV[PWVZ JVU[YH SVZ HU[xNLUVZ WVSPZHJmYPKVZ del neumococo, se le tomaron muestras de suero WHYHHUHSPaHYSVZ[x[\SVZWVZ]HJ\UHSLZ[YHZKxHZ KL JHKH PUT\UPaHJP}U" ZL \ZHYVU SVZ LX\PWVZ JVTLYJPHSLZ=HJJa`TL=HJJa`TL(U[P7*70N. ,0(;OL)PUKPUN:P[L9LPUV<UPKV ,ULS*\HKYVZLT\LZ[YHUSVZYLZ\S[HKVZKLSVZ estudios de laboratorio. No mostramos los resul[HKVZKLSHIPVX\xTPJHZtYPJHUPKLSOLTVNYHTH WVYX\L[VKVZSVZWHYmTL[YVZLZ[HIHUKLU[YVKL SVZ ]HSVYLZ UVYTHSLZ ,U[YL SVZ YLZ\S[HKVZ KL SHIVYH[VYPV TmZ KLZ[HJHISLZ ZL LUJ\LU[YH \UH distribución normal de las subpoblaciones linfoJP[HYPHZ`UVYTHSPKHKLULSWVYJLU[HQLKLJtS\SHZ )KLTLTVYPHWLYVJVUH\ZLUJPHKLJtS\SHZ)KL memoria con cambio de isotipo circulantes. Este OHSSHaNVUVLZL_JS\ZP]VWLYVZxMYLJ\LU[LLUSH PUT\UVKLÄJPLUJPH JVTU ]HYPHISL 3HZ JPMYHZ KL0N.M\LYVU!TNK30N4KLTNK3 LPUKL[LJ[HISLZKL0N(PUMLYPVYLZHTNK3 3VZ LZ[\KPVZ KL ]HJ\UHJP}U in vivo mostraron ]HSVYLZKL[LJ[HISLZKLHU[PJ\LYWVZ0N.JVU[YHLS [V_VPKL[L[mUPJV`JVU[YHSVZHU[xNLUVZWVSPZHJmYPKVZUL\TVJ}JPJVZJVULSL]HJP}UKL]HSVYLZ }W[PTHKLZW\tZKLSH]HJ\UHWYV[LPJH`YLZW\LZ[H T\`KPZTPU\PKHWHYHSH]HJ\UHUL\TVJ}JPJHHS UVPUJYLTLU[HYZLSVZ[x[\SVZLUTmZKL[YLZ]LJLZ LS]HSVYIHZHS"UVVIZ[HU[LLZ[L]HSVYZLTVZ[Y} KL[LJ[HISL`LU[x[\SVZKHKVZJVTVWYV[LJ[VYLZ +LIPKVHSHPTWVZPIPSPKHKKLTLKPYSH]HYPHJP}U LULS[x[\SVKLHU[PJ\LYWVZMYLU[LHSVZZLYV[PWVZKLSH]HJ\UHUL\TVJ}JPJHWVYZLWHYHKV `HSHULJLZPKHKKLKLTVZ[YHY\UHWYVK\JJP}U inadecuada de anticuerpos sin la interferencia KL WHY[PY KL SVZ [x[\SVZ KL[LJ[HISLZ ` LSL]HKVZ KL0N.JVU[YHSVZHU[xNLUVZWVSPZHJmYPKVZUL\TVJ}JPJVZX\LWVKYxHUSPTP[HYSHNLULYHJP}UKL una respuesta clara, decidimos administrar la 320 Volumen 62, Núm. 4, octubre-diciembre 2015 ]HJ\UH;`WOPT=P:HUVÄ7HZ[L\Y4:+-YHUJPH ,Z[H ]HJ\UH JVU[PLUL HU[xNLUVZ WVSPZHJmYPKVZ puros de Salmonella typhiLZJHWHaKLPUK\JPYSH LSL]HJP}UKLHU[PJ\LYWVZ0N.LZWLJxÄJVZKLZKL SHWYPTLYHPUT\UPaHJP}U4`HSN\UVZH\[VYLZSH JVUZPKLYHU\UHHS[LYUH[P]H]mSPKHWHYHL]HS\HY SHWYVK\JJP}UKLHU[PJ\LYWVZLZWLJxÄJVZ5 producidos mediante un mecanismo independiente KLSPUMVJP[VZ;LU\UJVU[L_[VKLTH`VYHWSPJHJP}ULUWVISHJP}UPUMHU[PS`HK\S[HKLSH]HJ\UH JVUQ\NHKHUL\TVJ}JPJHKLZLYV[PWVZSVX\L KPÄJ\S[HLSLZ[\KPVKLLZ[HZYLZW\LZ[HZ ,SLZ[\KPVKL]HJ\UHJP}UJVU[YHSVZHU[xNLUVZKL Salmonella typhi en nuestra paciente demostró JPMYHZPUKL[LJ[HISLZKLHU[PJ\LYWVZ0N.LZWLJxÄJVZLUSHL_[YHJJP}UWYL]PH`SHYLHSPaHKHHSVZ KxHZKLSHHKTPUPZ[YHJP}UKLSH]HJ\UHSVX\L WLYTP[P}THUPMLZ[HY\UHJHWHJPKHKPUZ\ÄJPLU[L KL WYVK\JJP}U KL HU[PJ\LYWVZ 0N. LZWLJxÄJVZ JVU[YHHU[xNLUVZWVSPZHJmYPKVZ 0U[LYWYL[HTVZSVZYLZ\S[HKVZKLSLZ[\KPV]HJ\UHS JVTV\UHKPZM\UJP}UWYVNYLZP]HTLU[LPUJHWHJP[HU[LKLSHWYVK\JJP}UKLHU[PJ\LYWVZ0N.MYLU[L HHU[xNLUVZWVSPZHJmYPKVZJVUJVUZLY]HJP}UKL SHYLZW\LZ[HMYLU[LHHU[xNLUVZ;KLWLUKPLU[LZ 3HWHJPLU[LM\LJHWHaKLYL[LULYSHWYVK\JJP}U IHZHSKLHU[PJ\LYWVZ0N.MYLU[LHSVZHU[xNLUVZ WVSPZHJmYPKVZKLSUL\TVJVJVHSVZX\LWYVIHISLTLU[LZLL_W\ZPLYHHU[LZKLSHPUZ[H\YHJP}U KLS KLMLJ[V L]PKLUJPmUKVZL \UH PUJHWHJPKHK WHYHSHLSL]HJP}UKLSVZ[x[\SVZJVUSHYLLZ[PT\SHJP}UJVUSH]HJ\UHUL\TVJ}JPJH3HWYVK\JJP}U KLHU[PJ\LYWVZ0N.MYLU[LHHU[xNLUVZ;PUKLWLUdientes presentados con posterioridad, como los de Salmonella typhiLZ[m[HTIPtUHIVSPKH DISCUSIÓN 3HWYVK\JJP}UKLÄJPLU[LKLHU[PJ\LYWVZLZWLJxÄJVZ*\HKYVLUU\LZ[YHWHJPLU[LJVUKtÄJP[ ZLSLJ[P]V KL 0N( WYVIHISLTLU[L LZ YLZWVUZHISL KL SH JVUJH[LUHJP}U KL SHZ PUMLJJPVULZ X\L OH WHKLJPKVZPIPLUUVLZZ\ÄJPLU[LWHYHLZ[HISLJLY Revista México Pleguezuelo DE y col. +tÄJP[ZLSLJ[P]VKL0N( *\HKYV ,Z[\KPVKLPUT\UPKHKO\TVYHS`JLS\SHY 7Y\LIH RLZ\S[HKVZ Valores de referencia Observaciones 0N. TNK3 3HZJPMYHZKL0N.LU[VKVZSVZZ\LYVZLZ[\KPHKVZ ZLTHU[\]PLYVUWVYLUJPTHKLTNK3 0N4 TNK3 3HZJPMYHZKL0N.LU[VKVZSVZZ\LYVZLZ[\KPHKVZ ZLTHU[\]PLYVUWVYLUJPTHKLTNK3 0N( #TN3 3HZJPMYHZKL0N(LU[VKVZSVZZ\LYVZLZ[\KPHKVZ TmZKLUVZLKL[LJ[HYVU 0N, 0N.-1 0N.-2 0N. 0N.-4 #2<3 N3 N3 N3 N3 0.24-1.25 0.052-1.25 TNK3 TNK3 <T3 JtS+3 KLSVZSL\JVJP[VZ 10-45 150-250 *omplemento* *omplemento* */ 3infocitos *tS\SHZ)*+ JtS+3 KLSVZSPUMVJP[VZ *tS\SHZ)de memoria *+ *+ 20 JtS+3 KLSVZSPUMVJP[VZ *tS\SHZ)aVUHTHYNPUHS *+ *+0.+ 20 JtS+3 KLSVZSPUMVJP[VZ *tS\SHZ)KL memoria con cambio de isotipo *+ *+0.+ 0UKL[LJ[HISLZ *tS\SHZ;*+ 3H0N.ZLLSL]}HN3LU\UZ\LYVWVZ[LYPVYZPLUKVZ\J\HU[PÄJHJP}U]HYPHISL 1,500 JtS+3 KLSVZSPUMVJP[VZ 3HZJVUJLU[YHJPVULZKLPUT\UVNSVI\SPUHZZtYPJHZ0N.0N(0N40N,`MYHJJPVULZKLSZPZ[LTHKLSJVTWSLTLU[V*`*ZL TPKPLYVUWVYTLKPVKLULMLSVTL[YxHJVU]LUJPVUHS0TTHNL)LJRTHU*V\S[LY 3HZJPMYHZKLZ\IJSHZLZKL0N.0N.0N.0N.L0N.ZLTPKPLYVUWVYTLKPVKL[\YIPKPTL[YxH;OL)PUKPUN:P[L 3HKL[LJJP}UKLHU[PJ\LYWVZLZWLJxÄJVZZLYLHSPa}JVUSVZLX\PWVZJVTLYJPHSLZ=HJJa`TL;OL)PUKPUN:P[L9LPUV<UPKV WHYH[V_VPKL[L[mUPJV"=HJJa`TL(U[P7*70N.,0(;OL)PUKPUN:P[L9LPUV<UPKVWHYHSHZ\THKLZLYV[PWVZKLStreptoccocus pneumoniae`=HJJA`TLS. typhi=P0N.,30:(RP[;OL)PUKPUN:P[L9LPUV<UPKVWHYHSHKL[LJJP}UKLHU[PJ\LYWVZ frente a Salmonella typhi. ,SLZ[\KPVKLZ\IWVISHJPVULZSPUMVJP[HYPHZZLYLHSPa}LU\U-(*:*HU[V00)LJRTHU*V\S[LY,Z[HKVZ<UPKVZ\ZHUKVSVZ Tt[VKVZYLJVTLUKHKVZWVYLSMHIYPJHU[L *\HKYV,Z[\KPVKLHU[PJ\LYWVZLZWLJxÄJVZ PY\LIH PYL]HJ\UH PVZ]HJ\UH Valores protectores (U[PJ\LYWVZ0N.JVU[YHHU[xNLUVZWYV[LPJVZKLS[V_VPKL [L[mUPJV <0T3 <0T3 TNK3 TNK3 #<T3 PUKL[LJ[HISL #<T3 PUKL[LJ[HISL :PU]HSVYLZKL referencia (U[PJ\LYWVZ 0N. JVU[YH HU[xNLUVZ WVSPZHJmYPKVZ neumocócicos (U[PJ\LYWVZ 0N. JVU[YH HU[xNLUVZ WVSPZHJmYPKVZ KL Salmonella typhi 321 Volumen 62, Núm. 4, octubre-diciembre 2015 Revista Alergia México LSKPHNU}Z[PJVKLPUT\UVKLÄJPLUJPHJVTU]HYPHISLHSUV[LULYJPMYHZKPZTPU\PKHZKL0N.KL HJ\LYKVJVUSVZJYP[LYPVZKLÄUPKVZLULS9LNPZ[YV KLSH:VJPLKHK,\YVWLHKL0UT\UVKLÄJPLUJPHZ ,\YVWLHU :VJPL[` MVY 0TT\UVKLMPJPLUJPLZ ,:0+6 No puede descartarse una forma progreZVYHOHJPHSHPUT\UVKLÄJPLUJPHJVTU]HYPHISL KLZKLSHKLÄJPLUJPHZLSLJ[P]HKL0N("ZPULTIHYNV LZMYLJ\LU[LLUJVU[YHYLULZ[VZWHJPLU[LZHKLTmZ KL\UKLZJLUZVWYVNYLZP]VKL0N.KPZTPU\JP}U KL 0N. X\L U\LZ[YH WHJPLU[L [HTWVJV [\]V (ZPTPZTVUVW\LKLLZ[HISLJLYZLLSKPHNU}Z[PJV YLJVUVJPKVJVTVKLÄJPLUJPHKLHU[PJ\LYWVZ0N. LZWLJxÄJVZHSZLYPUKL[LJ[HISLZSVZHU[PJ\LYWVZKL [PWV0N(LUZ\LYVUPSHZKLÄJPLUJPHZKLZ\IJSHZLZ HPZSHKHZ KL 0N. JVTV 0N. WVY LUJVU[YHYZL normales estas determinaciones. REFERENCIAS ϭ͘ /ŶƚĞƌŶĂƟŽŶĂůhŶŝŽŶŽĨ/ŵŵƵŶŽůŽŐŝĐĂů^ŽĐŝĞƟĞƐ͘WƌŝŵĂƌLJ ŝŵŵƵŶŽĚĞĮĐŝĞŶĐLJ ĚŝƐĞĂƐĞƐ͘ ZĞƉŽƌƚ ŽĨ ĂŶ /h/^ ^ĐŝĞŶƟĮĐ ŽŵŵŝƩĞĞ͘ůŝŶdžƉ/ŵŵƵŶŽůϭϵϵϵ͖ϭϭϴ͗ϭͲϮϴ͘ŝƐƉŽŶŝďůĞ ĞŶ͗ ŚƩƉ͗ͬͬŽŶůŝŶĞůŝďƌĂƌLJ͘ǁŝůĞLJ͘ĐŽŵͬĚŽŝͬϭϬ͘ϭϬϰϲͬũ͘ϭϯϲϱͲ ϮϮϰϵ͘ϭϵϵϵ͘ϬϬϭϬϵ͘džͬĂďƐƚƌĂĐƚ͖ũƐĞƐƐŝŽŶŝĚс&ϲϯϭϵϴϴϵ ϴϲϬϴ&ϳϱϴϱϱϳ&ϲϮϵϵ͘ĨϬϭƚϬϰ Ϯ͘ ŐŚĂŵŽŚĂŵŵĂĚŝ ͕ DŽŚĂŵŵĂĚŝ :͕ WĂƌǀĂŶĞŚ E͕ Ğƚ Ăů͘ WƌŽŐƌĞƐƐŝŽŶŽĨƐĞůĞĐƟǀĞ/ŐĚĞĮĐŝĞŶĐLJƚŽĐŽŵŵŽŶǀĂƌŝĂďůĞ ŝŵŵƵŶŽĚĞĮĐŝĞŶĐLJ͘/ŶƚƌĐŚůůĞƌŐLJ/ŵŵƵŶŽůϮϬϬϴ͖ϭϰϳ͗ϴϳͲ ϵϮ͘ ŝƐƉŽŶŝďůĞ ĞŶ͗ ŚƩƉ͗ͬͬǁǁǁ͘ŬĂƌŐĞƌ͘ĐŽŵͬƌƟĐůĞͬ&ƵůůͲ dĞdžƚͬϭϯϱϲϵϰ ϯ͘ KƌĂŶŐĞ :^͕ Ğƚ Ăů͘ hƐĞ ĂŶĚ ŝŶƚĞƌƉƌĞƚĂƟŽŶ ŽĨ ĚŝĂŐŶŽƐƟĐ ǀĂĐĐŝŶĂƚŝŽŶ ŝŶ ƉƌŝŵĂƌLJ ŝŵŵƵŶŽĚĞĨŝĐŝĞŶĐLJ͗ Ă ǁŽƌŬŝŶŐ ŐƌŽƵƉƌĞƉŽƌƚŽĨƚŚĞĂƐŝĐĂŶĚůŝŶŝĐĂů/ŵŵƵŶŽůŽŐLJ/ŶƚĞƌͲ ĞƐƚ^ĞĐƟŽŶŽĨƚŚĞŵĞƌŝĐĂŶĐĂĚĞŵLJŽĨůůĞƌŐLJ͕ƐƚŚŵĂ Θ /ŵŵƵŶŽůŽŐLJ͘ : ůůĞƌŐLJ ůŝŶ /ŵŵƵŶŽů ϮϬϭϮ͖ϭϯϬ͗ϭͲϮϰ͘ ŝƐƉŽŶŝďůĞ ĞŶ͗ ŚƩƉ͗ͬͬǁǁǁ͘ũĂĐŝŽŶůŝŶĞ͘ŽƌŐͬĂƌƟĐůĞͬ^ϬϬϵϭͲ ϲϳϰϵ;ϭϮͿϬϭϭϬϯͲϳͬĂďƐƚƌĂĐƚ ϰ͘ &ĞƌƌLJ>͕DŝƐďĂŚ^͕^ƚĞƉŚĞŶƐW͕ĞƚĂů͘ĞǀĞůŽƉŵĞŶƚŽĨ ĂŶ ĂŶƚŝͲSalmonella typhi sŝ >/^͗ ĂƐƐĞƐƐŵĞŶƚ ŽĨ ŝŵͲ ŵƵŶŽĐŽŵƉĞƚĞŶĐĞŝŶŚĞĂůƚŚLJĚŽŶŽƌƐ͘ůŝŶdžƉ/ŵŵƵŶŽů ϮϬϬϰ͖ϭϯϲ͗ϮϵϳͲϯϬϯ͘ŝƐƉŽŶŝďůĞĞŶ͗ŚƚƚƉ͗ͬͬŽŶůŝŶĞůŝďƌĂƌLJ͘ ǁŝůĞLJ͘ĐŽŵͬĚŽŝͬϭϬ͘ϭϭϭϭͬũ͘ϭϯϲϱͲϮϮϰϵ͘ϮϬϬϰ͘ϬϮϰϯϵ͘džͬ ĂďƐƚƌĂĐƚ ϱ͘ ^ĄŶĐŚĞnjͲZĂŵſŶ^͕ĚĞ'ƌĂĐŝĂ:͕'ĂƌĐşĂůŽŶƐŽ D͕ĞƚĂů͘ WƌŽƐƉĞĐƟǀĞ ƐƚƵĚLJ ;DWd,zͿ ŽĨ ƚŚĞ ĂŶƟďŽĚLJ ƌĞƐƉŽŶƐĞ ĂŐĂŝŶƐƚ S. Typhi ĨŽƌ ƚŚĞ ĞǀĂůƵĂƟŽŶ ŽĨ ĂŶƟͲƉŽůLJƐĂĐĐŚĂͲ ƌŝĚĞ ĂŶƟďŽĚLJ ƉƌŽĚƵĐƟŽŶ ĚĞĮĐŝĞŶĐLJ͘ ůŝŶ džƉ /ŵŵƵŶŽů ϮϬϭϯ͖ϭϳϰ͗ϮϳͲϱϱ͘ ŝƐƉŽŶŝďůĞ ĞŶ͗ ^ƉĞĐŝĂů /ƐƐƵĞ͗ ďƐƚƌĂĐƚƐ ŽĨ ƚŚĞ h< WƌŝŵĂƌLJ /ŵŵƵŶŽĚĞĮĐŝĞŶĐLJ DĞĞƟŶŐ ϮϬϭϯ͕ >ŝͲ ǀĞƌƉŽŽů͕h<͘ŚƩƉ͗ͬͬŽŶůŝŶĞůŝďƌĂƌLJ͘ǁŝůĞLJ͘ĐŽŵͬĚŽŝͬϭϬ͘ϭϭϭϭͬ ĐĞŝ͘ϭϮϮϭϴͬĨƵůů ϲ͘ ^ƚĞƉŚĂŶ Śů͕ Ğƚ Ăů͘ EĞǁ ĐůŝŶŝĐĂů ĚŝĂŐŶŽƐŝƐ ĐƌŝƚĞƌŝĂ ĨŽƌ ƚŚĞ ^/ ZĞŐŝƐƚƌLJ ϮϬϭϰ͘ ŝƐƉŽŶŝďůĞ ĞŶ͗ ŚƩƉ͗ͬͬĞƐŝĚ͘ŽƌŐͬ tŽƌŬŝŶŐͲWĂƌƟĞƐͬZĞŐŝƐƚƌLJͬŝĂŐŶŽƐŝƐͲĐƌŝƚĞƌŝĂ CONCLUSIONES 5\LZ[YHWHJPLU[LPS\Z[YHSHL_PZ[LUJPHKLMVYTHZ PU[LYTLKPHZLU[YLSHKLÄJPLUJPHZLSLJ[P]HKL0N( `SHPUT\UVKLÄJPLUJPHJVTU]HYPHISLX\LUV [PLULU KPZTPU\JP}U KL 0N. WLYV Zx \U J\HKYV JSxUPJVZ\NLYLU[LKLPUT\UVKLÄJPLUJPHO\TVYHS `X\LKLILUZLYYLJVUVJPKHZ`LZ[\KPHKHZWHYH PUPJPHYLS[YH[HTPLU[VHKLJ\HKVJVUVJLYJVUTmZ KL[HSSLSHL]VS\JP}UJSxUPJH`LSWYVU}Z[PJVHZx JVTVH`\KHYUVZHJVTWYLUKLYSHWH[VNLUPHKL LZ[LNY\WVKL[YHZ[VYUVZKLSHPUT\UPKHKO\TVYHS 322