Prevalence, aetiology, and hospital outcomes of paediatric acute critical illness in resource-constrained settings (Global PARITY): a multicentre, international, point prevalence and prospective cohort study / Eliana López Barón  

Público ISBD Título : Prevalence, aetiology, and hospital outcomes of paediatric acute critical illness in resource-constrained settings (Global PARITY): a multicentre, international, point prevalence and prospective cohort study Tipo de documento : documento electrónico Autores : Eliana López Barón, Autor Fecha de publicación : 2025 Títulos uniformes : The Lancet Global Health Idioma : Inglés (eng) Resumen : Background: Children in resource-constrained settings (RCS) have disproportionately high illness and mortality; however, the prevalence in RCS of paediatric acute critical illness (P-ACI; life-threatening conditions that require time-sensitive interventions) is unknown. Most P-ACI can be managed with basic critical care (stabilisation, fluid resuscitation, oxygen, and vital-organ support), but RCS hospitals often lack such essential services. This study estimated the prevalence and examined the aetiology of P-ACI among children at RCS hospitals to support critical care capacity building and inform resource allocation. Methods: We conducted a hybrid prospective cohort and multinational point prevalence study of acutely ill or injured children aged 28 days to 14 years who presented to RCS hospitals on four designated days between July 20, 2021, and July 12, 2022. We measured the proportion of participants with P-ACI, applying the definition for acute paediatric critical illness (DEFCRIT) framework for research in resource-variable settings, and followed up admitted patients for hospital outcomes. In participants with P-ACI, we report diagnoses associated with critical illness. We used descriptive statistics to summarise site and cohort data by country sociodemographic category (Socio-demographic Index; SDI) and multivariable logistic regression to assess whether country sociodemographic category was independently associated with P-ACI. Findings: The study included 46 sites, 19 countries, and 7538 children, among whom 2651 (35·2%) were admitted to hospital and 68 died (all-cause mortality 0·9% [95% CI 0·7–1·1]). 985 (13·1% [95% CI 12·3–13·9]) participants had P-ACI. Among all sociodemographic categories, P-ACI prevalence was highest (28·0% [26·0–30·1]; 512 of 1828 participants) in low-SDI countries (p Mención de responsabilidad : Kortz, Teresa B, Holloway, Adrian, Agulnik, Asya, He, David, Rivera, Stephanie Gordon, Abbas, Qalab, Appiah, John Adabie, Arias, Anita V, Attebery, Jonah, Camacho-Cruz, Jhon, Caporal, Paula, de Sa Rodrigues, Karla Emilia, Fink, Ericka, Kissoon, Niranjan, Lee, Jan Hau, López-Barón, Eliana, Murthy, Srinivas, Muttalib, Fiona, Nielsen, Katie, Remy, Kenneth, Sakaan, Andre-von Arnim, Amelie von Saint, Rodrigues, Adriana Teixeira, Blackwelder, William, Wiens, Matthew, Bhutta, Adnan, Abdul-Mumin, Alhassan, Allen, Nabisere, Amarillo, Paloma,Amegan-Aho, Kokou H, Arancibia, Pamela C, Arif, Fehmina, Arteaga, Liliana Y, Asibey, Jacqueline G, Ávila Guerrero, Nataly, Bacha, Tigist, Beltran Hernandez, Briam D, Bwiza Muhire, Hippolyte, Calderon-Cardenas, Juan S, Cañete, Mariana Lucía, Chimedbazar, Dulamragchaa, Curi, Claudia P, Emmanuel, Tenywa, Escobar, Maria L, Esposto, Sofia, Figueroa Vargas, Arieth, Fustiñana, Ana L, Giulietti, Marina, Habib, Muhammad Irfan, Havugarurema, Pascal, Hernandez Somerson Referencia : Lancet Glob Health . 2025 Feb;13(2):e212-e221. DOI (Digital Object Identifier) : 10.1016/S2214-109X(24)00450-9 PMID : 39890223 Derechos de uso : CC BY-NC-ND En línea : https://pubmed.ncbi.nlm.nih.gov/39890223/ Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_dis Prevalence, aetiology, and hospital outcomes of paediatric acute critical illness in resource-constrained settings (Global PARITY): a multicentre, international, point prevalence and prospective cohort study [documento electrónico] / Eliana López Barón, Autor . - 2025. Obra : The Lancet Global Health Idioma : Inglés (eng) Resumen : Background: Children in resource-constrained settings (RCS) have disproportionately high illness and mortality; however, the prevalence in RCS of paediatric acute critical illness (P-ACI; life-threatening conditions that require time-sensitive interventions) is unknown. Most P-ACI can be managed with basic critical care (stabilisation, fluid resuscitation, oxygen, and vital-organ support), but RCS hospitals often lack such essential services. This study estimated the prevalence and examined the aetiology of P-ACI among children at RCS hospitals to support critical care capacity building and inform resource allocation. Methods: We conducted a hybrid prospective cohort and multinational point prevalence study of acutely ill or injured children aged 28 days to 14 years who presented to RCS hospitals on four designated days between July 20, 2021, and July 12, 2022. We measured the proportion of participants with P-ACI, applying the definition for acute paediatric critical illness (DEFCRIT) framework for research in resource-variable settings, and followed up admitted patients for hospital outcomes. In participants with P-ACI, we report diagnoses associated with critical illness. We used descriptive statistics to summarise site and cohort data by country sociodemographic category (Socio-demographic Index; SDI) and multivariable logistic regression to assess whether country sociodemographic category was independently associated with P-ACI. Findings: The study included 46 sites, 19 countries, and 7538 children, among whom 2651 (35·2%) were admitted to hospital and 68 died (all-cause mortality 0·9% [95% CI 0·7–1·1]). 985 (13·1% [95% CI 12·3–13·9]) participants had P-ACI. Among all sociodemographic categories, P-ACI prevalence was highest (28·0% [26·0–30·1]; 512 of 1828 participants) in low-SDI countries (p Mención de responsabilidad : Kortz, Teresa B, Holloway, Adrian, Agulnik, Asya, He, David, Rivera, Stephanie Gordon, Abbas, Qalab, Appiah, John Adabie, Arias, Anita V, Attebery, Jonah, Camacho-Cruz, Jhon, Caporal, Paula, de Sa Rodrigues, Karla Emilia, Fink, Ericka, Kissoon, Niranjan, Lee, Jan Hau, López-Barón, Eliana, Murthy, Srinivas, Muttalib, Fiona, Nielsen, Katie, Remy, Kenneth, Sakaan, Andre-von Arnim, Amelie von Saint, Rodrigues, Adriana Teixeira, Blackwelder, William, Wiens, Matthew, Bhutta, Adnan, Abdul-Mumin, Alhassan, Allen, Nabisere, Amarillo, Paloma,Amegan-Aho, Kokou H, Arancibia, Pamela C, Arif, Fehmina, Arteaga, Liliana Y, Asibey, Jacqueline G, Ávila Guerrero, Nataly, Bacha, Tigist, Beltran Hernandez, Briam D, Bwiza Muhire, Hippolyte, Calderon-Cardenas, Juan S, Cañete, Mariana Lucía, Chimedbazar, Dulamragchaa, Curi, Claudia P, Emmanuel, Tenywa, Escobar, Maria L, Esposto, Sofia, Figueroa Vargas, Arieth, Fustiñana, Ana L, Giulietti, Marina, Habib, Muhammad Irfan, Havugarurema, Pascal, Hernandez Somerson Referencia : Lancet Glob Health . 2025 Feb;13(2):e212-e221. DOI (Digital Object Identifier) : 10.1016/S2214-109X(24)00450-9 PMID : 39890223 Derechos de uso : CC BY-NC-ND En línea : https://pubmed.ncbi.nlm.nih.gov/39890223/ Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_dis

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Clinical characteristics of children with SARS-CoV-2 infection in a hospital in Latin America / Laura Fernanda Niño Serna ; Eliana López Barón ; Isabel Cristina Maya Ángel ; Carolina Tamayo Múnera    

Público ISBD Título : Clinical characteristics of children with SARS-CoV-2 infection in a hospital in Latin America Tipo de documento : documento electrónico Autores : Laura Fernanda Niño Serna, ; Eliana López Barón, ; Isabel Cristina Maya Ángel, ; Carolina Tamayo Múnera, Fecha de publicación : 2022 Títulos uniformes : Frontiers in Pediatrics Idioma : Inglés (eng) Palabras clave : pediatrics  comorbidity  inpatients  pediatric intensive care unit  Latin America  COVID-19 Resumen : Objective: COVID-19 infections have shown a different behavior in children than in adults. The objective of this study was to describe the clinical characteristics and severity of SARS-CoV-2 infection in pediatric patients seen at a reference hospital in Colombia. Method: A descriptive, observational study in patients under the age of 18 years with a positive test for SARS-CoV-2 infection (RT-PCR or antigen) between April 2020 and March 2021. Multiple variables were studied, including demographic data, clinical characteristics, lab measurements, treatments administered, intensive care unit admission, and mortality. Results: A total of 361 patients were included of whom 196 (54%) were males. The median age was 3 years. Of all the patients, 65 (18%) were asymptomatic. The majority of patients had no comorbidities (n = 225, 76%). In those who were symptomatic (n = 296, 82%), the most frequent complaints were fever (n = 178, 60%), nasal congestion (n = 164, 55%) and cough (n = 149, 50%). Chest x-rays were normal in 73 patients (50%). When abnormalities were found, interstitial (29%) and alveolar (12%) patterns were the most prevalent. One hundred and fifty-seven children (53%) required general ward hospitalization, and 24 patients (8%) required pediatric intensive care admission. The global mortality was 0.8% (3 patients). Conclusions: The majority of cases were asymptomatic or mild. However, a significant percentage of patients required general ward admission, and some even required intensive care. The main symptom of COVID-19 infections in newborns was apnea. A second COVID-19 RT-PCR may be necessary to detect infections in critically ill patients with a high clinical suspicion of the disease if an initial test was negative. Mención de responsabilidad : Laura F. Niño-Serna, Eliana López-Barón, Isabel Cristina Maya Ángel and Carolina Tamayo-Múnera Referencia : Front Pediatr. 2022 Jun 9;10:921880. DOI (Digital Object Identifier) : 10.3389/fped.2022.921880 PMID : 35757135 Derechos de uso : CC BY En línea : https://www.frontiersin.org/articles/10.3389/fped.2022.921880/full Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_dis Clinical characteristics of children with SARS-CoV-2 infection in a hospital in Latin America [documento electrónico] / Laura Fernanda Niño Serna, ; Eliana López Barón, ; Isabel Cristina Maya Ángel, ; Carolina Tamayo Múnera,  . - 2022. Obra : Frontiers in Pediatrics Idioma : Inglés (eng) Palabras clave : pediatrics  comorbidity  inpatients  pediatric intensive care unit  Latin America  COVID-19 Resumen : Objective: COVID-19 infections have shown a different behavior in children than in adults. The objective of this study was to describe the clinical characteristics and severity of SARS-CoV-2 infection in pediatric patients seen at a reference hospital in Colombia. Method: A descriptive, observational study in patients under the age of 18 years with a positive test for SARS-CoV-2 infection (RT-PCR or antigen) between April 2020 and March 2021. Multiple variables were studied, including demographic data, clinical characteristics, lab measurements, treatments administered, intensive care unit admission, and mortality. Results: A total of 361 patients were included of whom 196 (54%) were males. The median age was 3 years. Of all the patients, 65 (18%) were asymptomatic. The majority of patients had no comorbidities (n = 225, 76%). In those who were symptomatic (n = 296, 82%), the most frequent complaints were fever (n = 178, 60%), nasal congestion (n = 164, 55%) and cough (n = 149, 50%). Chest x-rays were normal in 73 patients (50%). When abnormalities were found, interstitial (29%) and alveolar (12%) patterns were the most prevalent. One hundred and fifty-seven children (53%) required general ward hospitalization, and 24 patients (8%) required pediatric intensive care admission. The global mortality was 0.8% (3 patients). Conclusions: The majority of cases were asymptomatic or mild. However, a significant percentage of patients required general ward admission, and some even required intensive care. The main symptom of COVID-19 infections in newborns was apnea. A second COVID-19 RT-PCR may be necessary to detect infections in critically ill patients with a high clinical suspicion of the disease if an initial test was negative. Mención de responsabilidad : Laura F. Niño-Serna, Eliana López-Barón, Isabel Cristina Maya Ángel and Carolina Tamayo-Múnera Referencia : Front Pediatr. 2022 Jun 9;10:921880. DOI (Digital Object Identifier) : 10.3389/fped.2022.921880 PMID : 35757135 Derechos de uso : CC BY En línea : https://www.frontiersin.org/articles/10.3389/fped.2022.921880/full Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_dis

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Global PARITY: study design for a multi-centered, international point prevalence study to estimate the burden of pediatric acute critical illness in resource-limited settings / Eliana López Barón    

Público ISBD Título : Global PARITY: study design for a multi-centered, international point prevalence study to estimate the burden of pediatric acute critical illness in resource-limited settings Tipo de documento : documento electrónico Autores : Eliana López Barón, Fecha de publicación : 2022 Títulos uniformes : Frontiers in Pediatrics Idioma : Inglés (eng) Palabras clave : pediatric critical illness  acute pediatric care  critical care  outcome  low-and lower-middle-income countries  resource utilization  low resource setting Resumen : Background: The burden of pediatric critical illness and resource utilization by children with critical illness in resource limited settings (RLS) are largely unknown. Without specific data that captures key aspects of critical illness, disease presentation, and resource utilization for pediatric populations in RLS, development of a contextual framework for appropriate, evidence-based interventions to guide allocation of limited but available resources is challenging. We present this methods paper which describes our efforts to determine the prevalence, etiology, hospital outcomes, and resource utilization associated with pediatric acute, critical illness in RLS globally. Methods: We will conduct a prospective, observational, multicenter, multinational point prevalence study in sixty-one participating RLS hospitals from North, Central and South America, Africa, Middle East and South Asia with four sampling time points over a 12-month period. Children aged 29 days to 14 years evaluated for acute illness or injury in an emergency department) or directly admitted to an inpatient unit will be enrolled and followed for hospital outcomes and resource utilization for the first seven days of hospitalization. The primary outcome will be prevalence of acute critical illness, which Global PARITY has defined as death within 48 hours of presentation to the hospital, including ED mortality; or admission/transfer to an HDU or ICU; or transfer to another institution for a higher level-of-care; or receiving critical care-level interventions (vasopressor infusion, invasive mechanical ventilation, non-invasive mechanical ventilation) regardless of location in the hospital, among children presenting to the hospital. Secondary outcomes include etiology of critical illness, in-hospital mortality, cause of death, resource utilization, length of hospital stay, and change in neurocognitive status. Data will be managed via REDCap, aggregated, and analyzed across sites. Discussion: This study is expected to address the current gap in understanding of the burden, etiology, resource utilization and outcomes associated with pediatric acute and critical illness in RLS. These data are crucial to inform future research and clinical management decisions and to improve global pediatric hospital outcomes. Mención de responsabilidad : Qalab Abbas, Adrian Holloway, Paula Caporal, Eliana López-Barón, Asya Agulnik, Kenneth E. Remy, John A. Appiah, Jonah Attebery, Ericka L. Fink, Jan Hau Lee, Shubhada Hooli, Niranjan Kissoon, Erika Mille, Srinivas Murthy, Fiona Muttalib, Katie Nielsen, Maria Puerto-Torres, Karla Rodrigues, Firas Sakaan, Adriana Teixeira Rodrigues, Erica A. Tabor, Amelie von Saint Andre-von Arnim, Matthew O. Wiens, William Blackwelder, David He, Teresa B. Kortz and Adnan T. Bhutta on behalf of the PALISI Global Health Subgroup the Global PARITY Investigators Referencia : Front Pediatr. 2022 Jan 28;9:793326. DOI (Digital Object Identifier) : 10.3389/fped.2021.793326 PMID : 35155314 Derechos de uso : CC BY En línea : https://www.frontiersin.org/articles/10.3389/fped.2021.793326/full Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_dis Global PARITY: study design for a multi-centered, international point prevalence study to estimate the burden of pediatric acute critical illness in resource-limited settings [documento electrónico] / Eliana López Barón,  . - 2022. Obra : Frontiers in Pediatrics Idioma : Inglés (eng) Palabras clave : pediatric critical illness  acute pediatric care  critical care  outcome  low-and lower-middle-income countries  resource utilization  low resource setting Resumen : Background: The burden of pediatric critical illness and resource utilization by children with critical illness in resource limited settings (RLS) are largely unknown. Without specific data that captures key aspects of critical illness, disease presentation, and resource utilization for pediatric populations in RLS, development of a contextual framework for appropriate, evidence-based interventions to guide allocation of limited but available resources is challenging. We present this methods paper which describes our efforts to determine the prevalence, etiology, hospital outcomes, and resource utilization associated with pediatric acute, critical illness in RLS globally. Methods: We will conduct a prospective, observational, multicenter, multinational point prevalence study in sixty-one participating RLS hospitals from North, Central and South America, Africa, Middle East and South Asia with four sampling time points over a 12-month period. Children aged 29 days to 14 years evaluated for acute illness or injury in an emergency department) or directly admitted to an inpatient unit will be enrolled and followed for hospital outcomes and resource utilization for the first seven days of hospitalization. The primary outcome will be prevalence of acute critical illness, which Global PARITY has defined as death within 48 hours of presentation to the hospital, including ED mortality; or admission/transfer to an HDU or ICU; or transfer to another institution for a higher level-of-care; or receiving critical care-level interventions (vasopressor infusion, invasive mechanical ventilation, non-invasive mechanical ventilation) regardless of location in the hospital, among children presenting to the hospital. Secondary outcomes include etiology of critical illness, in-hospital mortality, cause of death, resource utilization, length of hospital stay, and change in neurocognitive status. Data will be managed via REDCap, aggregated, and analyzed across sites. Discussion: This study is expected to address the current gap in understanding of the burden, etiology, resource utilization and outcomes associated with pediatric acute and critical illness in RLS. These data are crucial to inform future research and clinical management decisions and to improve global pediatric hospital outcomes. Mención de responsabilidad : Qalab Abbas, Adrian Holloway, Paula Caporal, Eliana López-Barón, Asya Agulnik, Kenneth E. Remy, John A. Appiah, Jonah Attebery, Ericka L. Fink, Jan Hau Lee, Shubhada Hooli, Niranjan Kissoon, Erika Mille, Srinivas Murthy, Fiona Muttalib, Katie Nielsen, Maria Puerto-Torres, Karla Rodrigues, Firas Sakaan, Adriana Teixeira Rodrigues, Erica A. Tabor, Amelie von Saint Andre-von Arnim, Matthew O. Wiens, William Blackwelder, David He, Teresa B. Kortz and Adnan T. Bhutta on behalf of the PALISI Global Health Subgroup the Global PARITY Investigators Referencia : Front Pediatr. 2022 Jan 28;9:793326. DOI (Digital Object Identifier) : 10.3389/fped.2021.793326 PMID : 35155314 Derechos de uso : CC BY En línea : https://www.frontiersin.org/articles/10.3389/fped.2021.793326/full Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_dis

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Síndrome inflamatorio multisistémico en niños asociado a COVID-19. Revisión narrativa de la literatura a propósito de un caso / Carolina Giraldo Alzate ; Carolina Tamayo Múnera ; Eliana López Barón ; María Carolina Caicedo Báez ; Byron Enrique Piñeres Olave  

Público ISBD Título : Síndrome inflamatorio multisistémico en niños asociado a COVID-19. Revisión narrativa de la literatura a propósito de un caso Otros títulos : Multisystemic inflammatory syndrome associated with COVID-19 in children — Presentation of a case and a narrative review of the literature Tipo de documento : documento electrónico Autores : Carolina Giraldo Alzate, ; Carolina Tamayo Múnera, ; Eliana López Barón, ; María Carolina Caicedo Báez, ; Byron Enrique Piñeres Olave, Fecha de publicación : 2022 Títulos uniformes : Acta Colombiana de Cuidado Intensivo Idioma : Español (spa) Palabras clave : MIS-C  COVID-19  Niños  Cuidado intensivo pediátrico Resumen : Durante la pandemia actual, declarada por la Organización Mundial de la Salud en marzo de 2020, la literatura ha enfatizado que la enfermedad por SARS-CoV-2 en niños tiene un curso leve a moderado. Con el avance de la epidemia en las grandes ciudades del mundo se empezaron a reportar niños que presentaban características clínicas de un síndrome hiperinflamatorio, algunos con choque y compromiso multisistémico, con características similares a la enfermedad de Kawasaki y síndrome de choque tóxico, en pacientes previamente sanos, o con comorbilidades que cursan con infección reciente o actual por COVID-19 o con nexo epidemiológico claro para COVID-19, que fue denominada por el CDC como síndrome inflamatorio multisistémico en niños asociado a COVID-19 (MIS-C). En Colombia se han empezado a presentar este tipo de casos, pero hasta el momento no se tiene reporte clínico de los pacientes pediátricos con este diagnóstico. Se describe un caso de MIS-C con signos de choque distributivo y falla orgánica multisistémica. Se describen los hallazgos particulares en esta paciente y el tratamiento brindado, en vista de la ausencia de consensos regionales para el tratamiento de esta enfermedad. El caso descrito presenta evidencia de compromiso neurológico grave y sangrado de sistema nervioso central, poco descrito en la literatura pediátrica como una complicación potencialmente fatal. Se realizó una revisión narrativa de la literatura publicada hasta el momento. Mención de responsabilidad : Carolina Giraldo-Alzate, Carolina Tamayo-Múnera, Eliana López-Barón, María Carolina Caicedo-Baez y Byron Enrique Piñeres-Olave DOI (Digital Object Identifier) : 10.1016/j.acci.2020.11.002 En línea : https://linkinghub.elsevier.com/retrieve/pii/S0122726220301087 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_dis Síndrome inflamatorio multisistémico en niños asociado a COVID-19. Revisión narrativa de la literatura a propósito de un caso = Multisystemic inflammatory syndrome associated with COVID-19 in children — Presentation of a case and a narrative review of the literature [documento electrónico] / Carolina Giraldo Alzate, ; Carolina Tamayo Múnera, ; Eliana López Barón, ; María Carolina Caicedo Báez, ; Byron Enrique Piñeres Olave,  . - 2022. Obra : Acta Colombiana de Cuidado Intensivo Idioma : Español (spa) Palabras clave : MIS-C  COVID-19  Niños  Cuidado intensivo pediátrico Resumen : Durante la pandemia actual, declarada por la Organización Mundial de la Salud en marzo de 2020, la literatura ha enfatizado que la enfermedad por SARS-CoV-2 en niños tiene un curso leve a moderado. Con el avance de la epidemia en las grandes ciudades del mundo se empezaron a reportar niños que presentaban características clínicas de un síndrome hiperinflamatorio, algunos con choque y compromiso multisistémico, con características similares a la enfermedad de Kawasaki y síndrome de choque tóxico, en pacientes previamente sanos, o con comorbilidades que cursan con infección reciente o actual por COVID-19 o con nexo epidemiológico claro para COVID-19, que fue denominada por el CDC como síndrome inflamatorio multisistémico en niños asociado a COVID-19 (MIS-C). En Colombia se han empezado a presentar este tipo de casos, pero hasta el momento no se tiene reporte clínico de los pacientes pediátricos con este diagnóstico. Se describe un caso de MIS-C con signos de choque distributivo y falla orgánica multisistémica. Se describen los hallazgos particulares en esta paciente y el tratamiento brindado, en vista de la ausencia de consensos regionales para el tratamiento de esta enfermedad. El caso descrito presenta evidencia de compromiso neurológico grave y sangrado de sistema nervioso central, poco descrito en la literatura pediátrica como una complicación potencialmente fatal. Se realizó una revisión narrativa de la literatura publicada hasta el momento. Mención de responsabilidad : Carolina Giraldo-Alzate, Carolina Tamayo-Múnera, Eliana López-Barón, María Carolina Caicedo-Baez y Byron Enrique Piñeres-Olave DOI (Digital Object Identifier) : 10.1016/j.acci.2020.11.002 En línea : https://linkinghub.elsevier.com/retrieve/pii/S0122726220301087 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_dis

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