ABSTRACT
Traditional research methods have shown low predictive value for suicidal risk assessments and limitations to be applied in clinical practice. The authors sought to evaluate natural language processing as a new tool for assessing self-injurious thoughts and behaviors and emotions related. We used MEmind project to assess 2838 psychiatric outpatients. Anonymous unstructured responses to the open-ended question "how are you feeling today?" were collected according to their emotional state. Natural language processing was used to process the patients' writings. The texts were automatically represented (corpus) and analyzed to determine their emotional content and degree of suicidal risk. Authors compared the patients' texts with a question used to assess lack of desire to live, as a suicidal risk assessment tool. Corpus consists of 5,489 short free-text documents containing 12,256 tokenized or unique words. The natural language processing showed an ROC-AUC score of 0.9638 when compared with the responses to lack of a desire to live question. Natural language processing shows encouraging results for classifying subjects according to their desire not to live as a measure of suicidal risk using patients' free texts. It is also easily applicable to clinical practice and facilitates real-time communication with patients, allowing better intervention strategies to be designed.
Subject(s)
Suicidal Ideation , Suicide, Attempted , Humans , Suicide, Attempted/psychology , Emotions , Outpatients , Data MiningABSTRACT
Hemax® is an epoetin alfa product developed by Biosidus S.A. in Argentina at the end of the 1980s and has been present in that market since 1991. The initial presentation was a lyophilized powder containing albumin as stabilizer, to best adapt to environmental conditions in developing countries; more recently, a prefilled syringe, albumin-free presentation was developed, since this presentation has become the preferred standard in many markets. The primary objective was to compare the pharmacokinetic profile of different formulations of epoetin alfa after a single subcutaneous administration to healthy volunteers of 40 000 IU of Eprex/Erypo® and Hemax® PFS. This clinical trial was conceived following an open-label, randomized, three-way three-period cross-over balanced, and sequential design. The study was conducted on 24 healthy volunteers. To analyze similarity between Hemax® PFS and the innovator product, Eprex®, area under the curve (AUC) and Cmax of both products have been compared. The 90% CI lower limit for the geometric mean ratios was higher than 80% for any comparisons, and the 90% CI upper limit for these geometric ratios was below 125% for all the comparisons made, thus demonstrating equivalence between both products. The comparison between Hemax® PFS and Eprex® resulted in similar 90% CI for Cmax , AUC(0-120 h) and AUC(0-inf) ratios, all of them within the 80-125% interval, with a power above 95% for each ratio. These findings suggest biosimilar patterns for absorption velocity (with Tmax close to 15 h), absorption extent, and elimination (with an elimination half-life close to 25-30 h for each formulation).
Subject(s)
Erythropoietin , Humans , Epoetin Alfa/pharmacokinetics , Healthy Volunteers , Area Under Curve , Recombinant Proteins , Therapeutic Equivalency , Injections, SubcutaneousABSTRACT
OBJECTIVE: We compared the efï¬cacy, safety, and immunogenicity of a biosimilar recombinant human follicle-stimulating hormone (Folitime®) with Gonal-f® in women undergoing ovarian stimulation for in-vitro fertilization. METHODS: This randomized (1:1), multicenter, assessor-blinded, non-inferiority, parallel-group, controlled study conducted at four infertility clinics in Argentina included infertile normogonadotropic women with ages below 39 years, with menstrual cycles of 25/35 days and a body mass index of 18-32 kg/m2 undergoing assisted reproductive technology therapy. During a 5-day fixed-dose phase, the women received 225 IU/day of Folitime® (n=49) or Gonal-f® (n=44), followed by a dose-adaptation phase up to a maximum of 450 IU/day. The non-inferiority margin for oocyte retrieval was estimated at -4 oocytes (one-sided test). Immunogenicity was investigated on days 9 and 84, following the start of treatment. RESULTS: The mean number of oocytes retrieved was 12.6 (SD 7.4) in the Folitime® group and 13.4 (SD 6.9) in the Gonal-f® group (per protocol analysis, 95% confidence interval = -3.82; 2.33), within the non-inferiority margin. Pregnancy rate at week 10 was 24.4% among subjects treated with Folitime® and 19.5% for subjects treated with Gonal-f®. One serious adverse drug reaction-late mild ovarian hyper stimulation syndrome and deep venous thrombosis in the left deep jugular vein-occurred in a subject treated with Folitime®. None of the subjects developed antibodies against the study drugs. There were no unexpected safety findings. CONCLUSIONS: Folitime® is non-inferior to Gonal-f®, with no differences in the safety profile and has been approved as a biosimilar in Argentina.
Subject(s)
Biosimilar Pharmaceuticals , Adult , Biosimilar Pharmaceuticals/adverse effects , Female , Fertilization in Vitro , Follicle Stimulating Hormone, Human/adverse effects , Humans , Ovulation Induction , Pregnancy , Recombinant ProteinsABSTRACT
Blast Oxygen Furnace (BOF) slag represents one of the largest waste fractions from steelmaking. Therefore, slag valorisation technologies are of high importance regarding the use of slag as a secondary resource, both in the steel sector and in other sectors, such as the construction or cement industries. The main issue regarding the use of BOF slag is its volumetric instability in the presence of water; this hampers its use in sectors and requires a stabilisation pre-treatment. These treatments are also cost-inefficient and cause other environmental issues. This paper analyses the use of untreated BOF slag from a technical and environmental point of view, suggesting it as an alternative to natural aggregates in road surface layers and asphalt pavements. A comprehensive analysis of the requirements to be met by raw materials used in asphalt mixes was performed, and a pilot test was carried out with two different mixtures: one mix with limestone as coarse aggregate and another with 15% BOF slag. Furthermore, the global warming impacts derived from each mix with different aggregates were measured by Life Cycle Analysis (LCA), and a transport sensitivity analysis was also performed. The results show how the utilization of BOF slag as coarse aggregate in road construction improves the technical performance of asphalt mixtures (Marshall Quotient 4.9 vs. 6.6). Moreover, the introduction of BOF slag into the asphalt mix as a coarse aggregate, instead of limestone, causes a carbon emissions reduction rate of more than 14%.
ABSTRACT
BACKGROUND: Enerceptan (EtaBS) has been developed as a proposed biosimilar of etanercept. METHODS: This randomized, multicenter, evaluator-blinded, noninferiority study conducted in Argentina included adults with active, moderate, and severe rheumatoid arthritis with inadequate response to methotrexate. Subjects were randomly assigned to 32 weeks treatment with EtaBS (n = 99) or etanercept (n = 51) at a weekly 50-mg dose administered subcutaneously. Patients were categorized according to prior use of biologic disease-modifying antirheumatic drugs and concomitant use of steroids. The primary efficacy endpoint was ACR20 response rate at week 32. Safety, immunogenicity, and steady-state concentration of both drugs were evaluated. The noninferiority margin for ACR20 was estimated at 12%. RESULTS: In the per-protocol population, 85 subjects (92.4%) treated with EtaBS and 44 subjects (93.6%) treated with etanercept achieved ACR20 (difference, -1.2%; 95% confidence interval, -10.1% to 7.6%). Frequent adverse drug reactions occurred in 34.3% and 38% of subjects treated with EtaBS and etanercept, respectively. The most common reaction was upper respiratory tract infection. Six and 3 serious adverse events occurred in 4 and 3 subjects treated with EtaBS and etanercept, respectively. Injection site reactions occurred in 67.7% and 66.0% of subjects treated with EtaBS and etanercept, respectively. Two subjects treated with EtaBS and 1 subject treated with etanercept developed antibodies by week 32. CONCLUSIONS: Efficacy outcomes for EtaBS were noninferior to original etanercept in patients with moderate-to-severe rheumatoid arthritis with inadequate response to methotrexate. Safety and immunogenicity results were comparable between the two. This study is a major step toward improving access to biologics in Latin America.
Subject(s)
Antirheumatic Agents , Arthritis, Rheumatoid , Biosimilar Pharmaceuticals , Adult , Antirheumatic Agents/adverse effects , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/drug therapy , Biosimilar Pharmaceuticals/adverse effects , Double-Blind Method , Drug Therapy, Combination , Etanercept/adverse effects , Humans , Methotrexate/adverse effects , Treatment OutcomeABSTRACT
Within the most mesmerizing materials in the world of optoelectronics, mixed halide perovskites (MHPs) have been distinguished because of the tunability of their optoelectronic properties, balancing both the light-harvesting efficiency and the charge extraction into highly efficient solar devices. This feature has drawn the attention of analogous hot topics as photocatalysis for carrying out more efficiently the degradation of organic compounds. However, the photo-oxidation ability of perovskite depends not only on its excellent light-harvesting properties but also on the surface chemical environment provided during its synthesis. Accordingly, we studied the role of surface chemical states of MHP-based nanocrystals (NCs) synthesized by hot-injection (H-I) and anion-exchange (A-E) approaches on their photocatalytic (PC) activity for the oxidation of ß-naphthol as a model system. We concluded that iodide vacancies are the main surface chemical states that facilitate the formation of superoxide ions, O2â-, which are responsible for the PC activity in A-E-MHP. Conversely, the PC performance of H-I-MHP is related to the appropriate balance between band gap and a highly oxidizing valence band. This work offers new insights on the surface properties of MHP related to their catalytic activity in photochemical applications.
ABSTRACT
Se determinó el equilibrio líquido-líquido (ELL) de los sistemas ternarios benceno + (hexano, heptano y ciclohexano) con el líquido iónico 1-etil-3-metilimidazolio etilsulfato (EMIM-EtSO4) a 308,15 K; la selectividad (S) y el coeficiente de distribución (β) se calcularon desde los datos experimentales que se utilizaron para determinar la capacidad del líquido iónico como solvente para la separación del aromático desde sus mezclas con hidrocarburos alifáticos. La región de inmiscibilidad aumentó en el siguiente orden: ciclohexano < hexano < heptano. La consistencia de los datos experimentales del ELL es evaluado usando la ecuación de Othmer-Tobias. La composición de las fases en equilibrio se correlacionó con los modelos para coeficientes de actividad NRTL y Uniquac.
The equilibrium liquid-liquid (ELL) of ternary systems benzene + (hexane, heptane and cyclohexane) with the ionic liquid 1-ethyl-3-methylimidazolium ethylsulfate (EMIM-EtS0(4)) at 308.15 K, selectivity (S) and the distribution coefficient (β) are calculated from experimental data. The ability of ionic liquid as solvent for separation of the aromatic from their mixtures with ali-phatic hydrocarbons is analyzed. The region of immiscibility increased in the following order: cyclohexane < hexane < heptane. The consistency of the experimental data of ELL is evaluated using the equation of Othmer-Tobias. The composition of the phases in equilibrium is correlated with the models for the activity coeffcient NRTL and UNIQUAC.
O equilíbrio líquido-líquido (ELL) de los sistemas ternários benzeno + (hexa-no, heptano e ciclo-hexano) com o líquido iônico 1-etil-3-metilimidazólio etilsulfato (EMIM-EtS0(4)) com 308,15 K, seletividade (S) e o coeficiente de distribuição (β) são calculados a partir dos dados experimentais. Ela determina a capacidade de líquido iônico como solvente para a separação de aromático a partir de suas misturas com hidrocar-bonetos alifáticos. A região de imiscibilidade aumentou na seguinte ordem: ciclo-hexano < hexano < heptano. A consistência dos dados experimentais de ELL é avaliada usando a equação de Othmer-Tobias. A composição das fases de equilíbrio foi correlacionada com os modelos para coeficientes atividade NRTL e Uniquac.
ABSTRACT
Se midieron densidades e índices de refracción de mezclas binarias de agua, metanol y etanol con 1-Etil-3-metilimidazolio Etilsulfato (EMIM-EtSO4) y de etanol con 1-Metil-3-metilimidazolio Metilsulfato (MMIM-MeSO4) en el rango de temperatura de (298,15, 308,15 y 318,15) K. Se calcularon los volúmenes de exceso molar (V M E) y la desviación del índice de refracción (d n ), que se ajustaron a una ecuación polinomial de Redlich-Kister de orden cuatro.
Densities and refractive indices of binary mixtures of water, methanol and ethanol with 1-Ethyl-3-methylimidazolium Ethylsulfate (EMIM-EtSO4) and ethanol with 1-Methyl-3-methylimidazolium Methylsulfate (MMIM-MeSO4) in the temperature range (298.15, 308.15 and 318.15) K were measured. The excess of molar volumes (V M E) and the deviation of the refractive index (d n ), were fitted to an order fourth polynomial equation of Redlich-Kister.
Determinam-se densidades e índices de refração de misturas binárias de água, metanol e etanol com 1-Etil-3-metilimidazólio Etilsulfato (EMIM-EtSO4) e de etanol com 1-Metil-3-metilimidazólio Metilsulfato (MMIM-MeSO4) no intervalo de temperatura (298,15, 308,15 e 318,15) K. Se calcularam os volumes de excesso molar (V M E) eo desvio do índice de refração (d n ), ajustados áuma equação polinomial de Redlich-Kisterde ordem quatro.
ABSTRACT
The effects of growth hormone (GH) on infarct size and left ventricular (LV) function in experimental acute myocardial infarction (AMI) have been controversial. Moreover, little, if any, information exists regarding long-term evaluation of therapeutic doses of GH in large mammalian models of AMI. We therefore aimed to assess the effect of therapeutic doses of GH over 3.5 months on infarct size and heart function in sheep with AMI. After coronary artery ligation, sheep received subcutaneous human GH 8 IU/d (n = 8) or vehicle (n = 8) over 100 days. Infarct area was similar in GH (16.9% +/- 3% of LV area) and placebo (16.5% +/- 3.7%, P = not significant) sheep. At 3 days of treatment onset, but not at later times, GH sheep had higher LV shortening fraction (30.7% +/- 3.5% vs. 24.8% +/- 6.1%, P < 0.04), systolic anterior wall thickness (10.1 +/- 0.8 vs. 8.6 +/- 1.2 mm, P < 0.02), and cardiac index (3.8 +/- 0.6 vs. 2.8 +/- 0.7 L x min x m, P < 0.01). This evolution of function parameters paralleled that of serum insulin-like growth factor 1 levels, which differed significantly only during the first week, suggesting a direct effect of GH on LV contractility. These results may suggest the usefulness of therapeutic doses of GH at the early phases of AMI but do not support maintaining the treatment for longer time.
Subject(s)
Coronary Occlusion/complications , Human Growth Hormone/pharmacology , Myocardial Infarction/drug therapy , Ventricular Function, Left/drug effects , Animals , Disease Models, Animal , Dose-Response Relationship, Drug , Human Growth Hormone/administration & dosage , Injections, Subcutaneous , Insulin-Like Growth Factor I/metabolism , Male , Myocardial Infarction/physiopathology , Sheep , Time FactorsABSTRACT
Blastoferon, in the following referred to as the test product, is a pharmaceutical product of interferon beta la (CAS 220581-49-7) currently marketed as a biosimilar to the innovator Interferon beta la product (referred to as the reference product). Pharmacokinetics and pharmacodynamIcs assays are critically relevant to demonstrate similarity between biopharmaceuticals. The aims of the present study were to investigate the bioavailability (BA) of the test product (either absolute or relative to the innovator product) and to compare the extent of increase of neopterin concentration following administration of either product. Two studies were performed: initially, an absolute BA assay with i.v. and s.c. injection of test product to 12 healthy subjects. Second, a formal relative BA study with s.c. injections of 88 microg of both products to 24 healthy volunteers. Blood samples for pharmacokinetic and pharmacodynamic profiling were drawn at different intervals after injection. Interferon beta (IFNB) concentrations were determined by ELISA. In the absolute BA study, a single s.c. dose of 44 microg of the test product resulted in a median bioavailable fraction of 29%, a median T(max) of 4 h (4-6) and a C(max) of 3.69 (3.27-4.41) IU x ml(-1). In the relative BA study, values for the test product were: median T(max) of 3 h (2-18), C(max) of 5.39 (4.99-6.31) IU x ml(-1), AUC (0-72) of 142.86 (134.16-190.15) IU x h x ml(-1) and AUC(0-infinity) of 190.95 (174.23-303.13) IU x h x ml(-1). The corresponding values for the innovator product were: T(max) of 3 h (1-24), C(max) of 4.44 (4.12-5.40) IU x ml(-1), AUC(0-72) of 128.77 (121.18-170.92) IU x h x ml(-1) and AUC(0-affinity) of 192.61 (183.04-286.46) IU x h x ml(-1). The AUC(0-72) ratio was 111% (CI 90%: 106-116), the AUC(0-affinity) was 99% (CI 90%: 92-107) and the C(max) ratio was 121% (CI 90%: 112-131). IFNB1a increased neopterin levels in both studies. Both products induced side-effects commonly reported for IFN with no serious adverse events. This study presents pharmacokinetics parameters of the test product and demonstrates similar bioavailability of IFNB1a for both pharmaceutical products.
Subject(s)
Immunologic Factors/pharmacokinetics , Interferon Type I/pharmacokinetics , Adult , Area Under Curve , Biological Availability , Enzyme-Linked Immunosorbent Assay , Female , Humans , Immunologic Factors/administration & dosage , Immunologic Factors/adverse effects , Injections, Intravenous , Injections, Subcutaneous , Interferon Type I/administration & dosage , Interferon Type I/adverse effects , Male , Neopterin/blood , Recombinant Proteins , Therapeutic EquivalencyABSTRACT
Transgenic farm animals have been proposed as an alternative to current bioreactors for large scale production of biopharmaceuticals. However, the efficiency of both methods in the production of the same protein has not yet been established. Here we report the production of recombinant human growth hormone (hGH) in the milk of a cloned transgenic cow at levels of up to 5 g l(-1). The hormone is identical to that currently produced by expression in E. coli. In addition, the hematological and somatometric parameters of the cloned transgenic cow are within the normal range for the breed and it is fertile and capable of producing normal offspring. These results demonstrate that transgenic cattle can be used as a cost-effective alternative for the production of this hormone.
Subject(s)
Animals, Genetically Modified/genetics , Cattle/genetics , Cloning, Organism , Human Growth Hormone/biosynthesis , Milk Proteins/biosynthesis , Recombinant Proteins/biosynthesis , Animals , Animals, Genetically Modified/embryology , HumansABSTRACT
The ionic mean activity coefficients of NaCl in trehalose-water and maltose-water mixtures have been experimentally determined at 298.15 K from emf measurements by electrochemical cell containing ion selective electrodes (ISE): Na-ISE/NaCl (m), sugar (Y%), H(2)O (100-Y%)/Cl-ISE. The electrolyte molality (m) ranged between 0.01 and 3 mol kg(-1), approximately, and the weight percent (Y%) of sugar in the mixture of solvents between 0, 10, 20, 30 and 40%. The system is considered as an electrolyte in a mixture of solvents and the data have been analysed by using the Debye-Hückel and Pitzer equations. The results obtained with both equations are in quite agreement with each other. The variation of the fit parameter from both equations were studied relative to the change in the dielectric properties of the mixture of solvents. Standard free energy of transference were comparatively discussed in terms of ion-solvent, ion-ion interactions and the hydration of both the electrolyte and the sugar.
Subject(s)
Maltose/chemistry , Sodium Chloride/chemistry , Trehalose/chemistry , Water/chemistry , Chemical Phenomena , Chemistry, Physical , TemperatureABSTRACT
Los tumores de la nasofaringe son poco frecuentes en la infancia. Su forma clínica de presentación característica y la posibilidad de realizar un diagnóstico temprano e indicar el tratamiento oportuno, permitiría modificar favorablemente la evolución y el pronóstico de estos pacientes. Se reporta una serie de 4 niños con tumores de la nasofaringe (2 linfoepiteliomas y 2 neuroblastomas) atendidos en el Hospital Infantil Docente ôPedro Borrás Astorgaö. Todos los pacientes mostraron en algún momento de su evolución obstrucción nasal unilateral y epistaxis. El 50 (por ciento) de los casos comenzó su enfermedad presentando cefaleas y uno de ellos lo hizo con compromiso de pares craneales (VII, VI, IV, VI). La radioterapia representa la modalidad de tratamiento más útil y la resonancia magnética nuclear resulta de gran valor para el diagnóstico inicial, así como para la identificación de la recidiva tumoral(AU)
Subject(s)
Male , Child , Nasopharyngeal Neoplasms/diagnosis , Radiotherapy/methods , Magnetic Resonance Spectroscopy/methodsABSTRACT
Los tumores de la nasofaringe son poco frecuentes en la infancia. Su forma clínica de presentación característica y la posibilidad de realizar un diagnóstico temprano e indicar el tratamiento oportuno, permitiría modificar favorablemente la evolución y el pronóstico de estos pacientes. Se reporta una serie de 4 niños con tumores de la nasofaringe (2 linfoepiteliomas y 2 neuroblastomas) atendidos en el Hospital Infantil Docente ôPedro Borrás Astorgaö. Todos los pacientes mostraron en algún momento de su evolución obstrucción nasal unilateral y epistaxis. El 50 (por ciento) de los casos comenzó su enfermedad presentando cefaleas y uno de ellos lo hizo con compromiso de pares craneales (VII, VI, IV, VI). La radioterapia representa la modalidad de tratamiento más útil y la resonancia magnética nuclear resulta de gran valor para el diagnóstico inicial, así como para la identificación de la recidiva tumoral
Subject(s)
Male , Child , Nasopharyngeal Neoplasms , RadiotherapyABSTRACT
Se realiza una revisión bibliográfica sobre enfisema lobal congénito (ELC). Se presentan 3 pacientes que mostraban esta malformación pulmonar diagnosticada en nuestro centro. Se hace el diagnóstico de una forma casual en la paciente 1, pues estaba asintomática. Se considera como un hallazgo radiográfico el ELC. Se corrobora en los pacientes 2 y 3, operados, el diagnóstico clínico-radiográfico con el anatomopatológico. A pesar de lo característico del cuadro clínico-radiográfico no se diagnosticó de inicio la entidad, por lo que se considera debe tenerse presente la posibilidad del diagnóstico de ELC en todo lactante de menos de 6 meses que presente dificultad respiratoria importante
Subject(s)
Infant, Newborn , Infant , Humans , Male , Female , Pulmonary Emphysema/congenital , Pulmonary EmphysemaABSTRACT
Se realiza una revisión bibliográfica sobre enfisema lobal congénito (ELC). Se presentan 3 pacientes que mostraban esta malformación pulmonar diagnosticada en nuestro centro. Se hace el diagnóstico de una forma casual en la paciente 1, pues estaba asintomática. Se considera como un hallazgo radiográfico el ELC. Se corrobora en los pacientes 2 y 3, operados, el diagnóstico clínico-radiográfico con el anatomopatológico. A pesar de lo característico del cuadro clínico-radiográfico no se diagnosticó de inicio la entidad, por lo que se considera debe tenerse presente la posibilidad del diagnóstico de ELC en todo lactante de menos de 6 meses que presente dificultad respiratoria importante
Subject(s)
Infant, Newborn , Infant , Humans , Male , Female , Pulmonary Emphysema , Pulmonary Emphysema/congenitalABSTRACT
Se revisaron 1052 historias clínicas de pacientes egresados del Hospital Pedro Borrás Astorga con el diagnóstico de meningoencefalitis viral no urleana, en el período comprendido de octubre de 1985 a marzo de 1986, periódico en consulta externa durante 1 año. Se analizaron comparativamente los egresados por meses en el semestre, la edad, sexo, estado nutricional, antecedentes patológicos personales tiempo que medió desde el inicio de la enfermedad a su ingreso, síntomas y signos de su comienzo, impresión diagnóstica con que fueron ingresados, evolución y complicaciones(AU)
Subject(s)
Humans , Male , Female , MeningoencephalitisABSTRACT
Se revisaron 1 052 historias clínicas de pacientes egresados del Hospital Infantil Docente "Pedro Borrás Astorga" con el diagnóstico de meningoencefalitis viral no urleana, en el periodo comprendido de octubre de 1985 a marzo de 1986, a los que se les realizó un seguimiento periódico en consulta externa durane 1 año. Se analizaron comparativamente los egresados por meses en el semestre, la edad, sexo, estado nutricional, antecedentes patológicos personales, tiempo que medió desde el inicio de la enfermedada su ingreso, síntomas y signos de su comienzo, impresión diagnóstica conque fueron ingresados, evolución y complicacione
Subject(s)
Infant , Child, Preschool , Child , Adolescent , Humans , Male , Female , Meningoencephalitis , Retrospective StudiesABSTRACT
Se revisaron 1 052 historias clínicas de pacientes egresados del hospital infantil docente "Pedro Borrás Astorga" con el diagnóstico de meningoencefalitis viral no urleana, en el periodo comprendido del 1 de octubre de 1985 al 31 de marzo de 1986. En este estudio se analizaron especialmente las historias clínicas de los 3 fallecidos mediante los datos de mayor interés como: edad, sexo, color de la piel, estadía, impresión diagnóstica al ingreso, motivo del ingreso, historia de la enfermedad, exámenes físico y complementarios y especialmente los resultados anatomopatológicos. Se llegan a conclusiones
